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schedule","standard_charge_dollar":6691.0}]}]},{"description":"Prq card revasc chronic addl","code_information":[{"code":"92944","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6691.0,"maximum":7872.0,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7872.0},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6691.0}]}]},{"description":"Pild/placebo control clin tr","code_information":[{"code":"G0276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6358.75,"maximum":15896.88,"payers_information":[{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.69,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6485.93,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6549.52,"additional_payer_notes":"APC"},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6803.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7872.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15896.88,"additional_payer_notes":"Radiology"},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6691.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6358.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.1,"additional_payer_notes":"APC"}]}]},{"description":"Prq card angio/athrect addl","code_information":[{"code":"92925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7281.0,"maximum":8566.0,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8566.0},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7281.0}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15417.52,"maximum":34937.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15490.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34937.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29696.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15725.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27949.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15880.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27223.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16496.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16496.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27071.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23010.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15417.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3920.98,"10th_percentile":3920.98,"90th_percentile":3920.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8761.13,"maximum":19759.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8761.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9720.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19759.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16795.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9442.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15807.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15397.0},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9905.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9905.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15311.12},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13014.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9627.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8736.34,"10th_percentile":8736.34,"90th_percentile":8736.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6694.7,"maximum":15099.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6694.7},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7734.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15099.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12834.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7513.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12079.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7586.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11765.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7881.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7881.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11699.79},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9944.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13240.2,"maximum":29861.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13240.2},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29861.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25382.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13624.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23889.36},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13758.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23268.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14292.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14292.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23138.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19667.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13357.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":17346.41,"10th_percentile":17346.41,"90th_percentile":17346.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12440.84,"10th_percentile":11111.02,"90th_percentile":12722.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":12532.93,"10th_percentile":12085.79,"90th_percentile":12864.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9501.17,"10th_percentile":9501.17,"90th_percentile":9501.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7103.21,"maximum":16020.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7103.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16020.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13617.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12816.36},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12483.33},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12413.7},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10551.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7739.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8049.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":14584.97,"10th_percentile":14584.97,"90th_percentile":20440.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7405.02,"10th_percentile":7374.92,"90th_percentile":7405.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":7229.77,"10th_percentile":6995.38,"90th_percentile":7475.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7303.67,"10th_percentile":7303.67,"90th_percentile":7303.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4565.99,"maximum":10298.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4565.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5688.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10298.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8753.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5525.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8238.43},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5579.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8024.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5796.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5796.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7979.6},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6782.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5634.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":8556.05,"10th_percentile":8556.05,"90th_percentile":8556.05},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4983.16,"10th_percentile":4983.16,"90th_percentile":4983.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14212.21,"maximum":32053.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14212.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14959.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32053.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27245.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14532.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25643.17},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14674.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24976.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15244.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15244.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24837.53},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21111.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14247.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14817.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7847.79,"maximum":17699.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7847.79},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8842.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17699.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15044.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14159.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8674.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13791.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9010.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9010.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13714.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11657.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5798.75,"maximum":13078.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5798.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6873.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13078.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11116.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10462.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6742.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10190.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7004.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7004.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10133.99},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8613.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6545.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":445.0,"10th_percentile":445.0,"90th_percentile":445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10000.41,"maximum":22554.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10000.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22554.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19171.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10599.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18043.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17574.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17476.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14854.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10391.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10807.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6800.69,"10th_percentile":6800.69,"90th_percentile":6800.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6191.32,"maximum":13963.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6191.32},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7250.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13963.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11869.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7043.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11171.02},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7112.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10880.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10820.06},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9196.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7181.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5268.56,"maximum":11882.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5268.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6363.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11882.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10100.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9506.09},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6242.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9259.07},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9207.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7826.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5856.02,"10th_percentile":5856.02,"90th_percentile":5856.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7395.1,"maximum":16678.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7395.1},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8407.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16678.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14176.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8167.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13343.02},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8247.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12996.31},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8567.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8567.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12923.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10984.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8327.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12842.56,"maximum":28964.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12842.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13643.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28964.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24620.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23171.9},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13383.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22569.79},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13903.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13903.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22443.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19076.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12993.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13513.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5075.89,"maximum":11448.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5075.89},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6178.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11448.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9730.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9158.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8920.48},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8870.73},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7539.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5884.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6119.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7244.45,"maximum":16339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7244.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16339.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13888.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8026.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13071.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8105.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12731.55},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8420.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8420.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12660.53},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10761.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7869.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2000.0,"10th_percentile":2000.0,"90th_percentile":2000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11530.13,"maximum":26004.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11530.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12381.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26004.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22104.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12028.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20803.87},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12145.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20263.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12617.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12617.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20150.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17127.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12263.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":54932.5,"10th_percentile":54932.5,"90th_percentile":54932.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":6045.11,"10th_percentile":6045.11,"90th_percentile":6045.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17244.77,"maximum":39439.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17486.77},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18107.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39439.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33523.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17589.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31551.47},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17762.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30731.62},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18451.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18451.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30560.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25975.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17244.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17934.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24035.96,"maximum":56172.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24905.78},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25237.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56172.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47746.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24516.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44937.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24757.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43769.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25718.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25718.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43525.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36995.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24035.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24997.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10124.99,"maximum":22835.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10124.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22835.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19410.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10716.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18268.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10821.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17793.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17694.62},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15040.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10505.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16656.02,"maximum":37988.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16843.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17488.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37988.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32290.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16989.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30390.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17155.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29601.29},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17821.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17821.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29436.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25020.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16656.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14807.0,"10th_percentile":14807.0,"90th_percentile":14807.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30362.38,"maximum":71759.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31817.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31880.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":71759.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60995.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57407.66},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31273.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":55915.95},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32487.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32487.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55604.06},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47262.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30362.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31576.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28838.24,"10th_percentile":28838.24,"90th_percentile":28838.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22144.46,"10th_percentile":22144.46,"90th_percentile":22144.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9741.84,"maximum":21971.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9741.84},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21971.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18675.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10358.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17577.24},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10459.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17120.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17025.01},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14470.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10155.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10561.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":34075.5,"10th_percentile":34075.5,"90th_percentile":34075.5},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9768.99,"10th_percentile":9768.99,"90th_percentile":9768.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12185.62,"maximum":27483.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12185.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13011.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27483.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23360.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12640.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21986.58},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12763.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21415.27},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13259.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13259.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21295.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18100.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12392.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20478.26,"maximum":47406.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21019.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47406.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40295.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20887.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37925.02},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21092.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36939.56},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21911.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36733.52},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31222.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20478.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21297.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8458.38,"maximum":19076.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8458.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19076.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16215.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9159.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15261.49},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9249.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14864.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14782.01},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12564.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9339.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11041.95,"maximum":24903.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11041.95},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24903.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21168.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11572.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19923.05},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11685.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19405.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19297.12},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16402.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11799.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":1676.0,"10th_percentile":1676.0,"90th_percentile":1676.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17759.26,"maximum":40707.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18048.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18647.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40707.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34600.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18114.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32565.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18292.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31719.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19002.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19002.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31542.47},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26810.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17759.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18469.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6305.76,"maximum":14221.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6305.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7360.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14221.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12088.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7150.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11377.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7220.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11081.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11020.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9366.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6460.41,"10th_percentile":6460.41,"90th_percentile":6460.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9479.64,"maximum":21380.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9479.64},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21380.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18173.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10113.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17104.16},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10212.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16659.72},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16566.79},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14081.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9915.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10311.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16457.78,"maximum":37500.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16627.03},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17280.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37500.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31875.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16786.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30000.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16951.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29220.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17609.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17609.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29057.7},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24698.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16457.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17116.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8591.65,"maximum":19377.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8591.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9557.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19377.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16470.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9284.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15501.95},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9375.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15099.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9739.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9739.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15014.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12762.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9466.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8842.22,"10th_percentile":8842.22,"90th_percentile":8842.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10898.54,"maximum":24580.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10898.54},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11774.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24580.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20893.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11438.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19664.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11550.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19153.33},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11999.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11999.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19046.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16189.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11662.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18361.94,"maximum":42191.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18707.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19280.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42191.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35863.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18729.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33753.53},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18912.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32876.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19647.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19647.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32693.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27788.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18361.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19096.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11118.01,"maximum":25075.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11118.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25075.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21314.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11643.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20060.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11757.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19539.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19430.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16515.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11414.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11871.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15218.62,"maximum":34447.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15273.31},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15979.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34447.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29280.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27557.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15675.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26841.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16283.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16283.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26691.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22687.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15218.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15827.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":18446.81,"10th_percentile":18446.81,"90th_percentile":18446.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":31618.68,"10th_percentile":31618.68,"90th_percentile":31618.68},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24913.12,"maximum":58333.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25864.03},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26158.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58333.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49583.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25411.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46666.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25660.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45453.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26657.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26657.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45200.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38419.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24913.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25909.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11863.31,"maximum":26756.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11863.31},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12702.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26756.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22742.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12339.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21405.03},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12460.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20848.83},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12943.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12943.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20732.54},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17622.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12581.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16766.74,"maximum":38261.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16964.55},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17605.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38261.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32522.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17102.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30609.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17269.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29813.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17940.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17940.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29647.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25199.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16766.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17437.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25243.29,"maximum":59146.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26224.73},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26505.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59146.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50274.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25748.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47317.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26000.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46087.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27010.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27010.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45830.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38955.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25243.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26253.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12189.24,"maximum":27491.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12189.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27491.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23367.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12643.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21993.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12767.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21421.63},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21302.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18106.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12395.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12891.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":23603.53,"10th_percentile":23603.53,"90th_percentile":23869.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":25908.09,"10th_percentile":25908.09,"90th_percentile":25908.09},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":21741.61,"10th_percentile":21741.61,"90th_percentile":21741.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":3302.06,"10th_percentile":3302.06,"90th_percentile":3302.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11461.75,"10th_percentile":11461.75,"90th_percentile":11918.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10883.17,"10th_percentile":10883.17,"90th_percentile":10883.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17131.39,"maximum":39160.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17362.92},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17987.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39160.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33286.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17474.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31328.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17645.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30513.96},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18330.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18330.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30343.76},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25791.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17131.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17816.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":33223.16,"10th_percentile":30202.42,"90th_percentile":39973.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":3188.47,"10th_percentile":3188.47,"90th_percentile":3188.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16043.28,"10th_percentile":16037.28,"90th_percentile":16453.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31712.92,"maximum":75087.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33292.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33298.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":75087.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63824.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32347.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60069.73},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32664.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58508.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33932.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33932.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58182.5},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49453.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31712.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32981.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":39320.0,"10th_percentile":39320.0,"90th_percentile":39320.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30128.93,"10th_percentile":30128.93,"90th_percentile":30128.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":24919.12,"10th_percentile":24919.12,"90th_percentile":24919.12},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":150828.88,"10th_percentile":150828.88,"90th_percentile":150828.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30288.49,"10th_percentile":26096.36,"90th_percentile":30433.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11605.46,"maximum":26174.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11605.46},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12454.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26174.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22248.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12098.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20939.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12216.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20395.68},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12691.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12691.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20281.91},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17239.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12335.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":31839.86,"10th_percentile":31839.86,"90th_percentile":31839.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17443.01,"maximum":39927.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17703.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18315.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39927.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33938.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17791.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31942.22},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31112.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18664.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18664.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30938.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26297.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17443.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18140.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34304.62,"maximum":81472.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36123.74},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36019.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":81472.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69251.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34990.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65178.24},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35333.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":63484.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36705.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36705.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63130.51},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53659.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34304.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35676.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33401.56,"10th_percentile":32915.13,"90th_percentile":33409.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22522.97,"maximum":52444.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23252.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23649.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52444.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44577.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41955.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40865.18},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24099.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24099.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40637.24},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34540.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22522.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23423.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14377.49,"10th_percentile":14377.49,"90th_percentile":14377.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22129.15,"maximum":51473.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22822.69},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23235.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51473.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43752.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22571.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41179.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22793.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40109.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23678.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23678.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39885.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33901.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22129.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23014.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":48299.62,"10th_percentile":48299.62,"90th_percentile":48299.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29928.77,"maximum":70691.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31343.36},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31425.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":70691.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60087.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30527.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56552.97},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30826.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":55083.47},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32023.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32023.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54776.23},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46558.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29928.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31125.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1659.35,"10th_percentile":1659.35,"90th_percentile":1659.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27880.46,"10th_percentile":27880.46,"90th_percentile":27880.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28146.57,"10th_percentile":28146.57,"90th_percentile":28146.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12769.41,"maximum":28799.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12769.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28799.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24479.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13185.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23039.91},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13314.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22441.23},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13831.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13831.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22316.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18968.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12926.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13443.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":17460.42,"10th_percentile":17460.42,"90th_percentile":17460.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":26650.54,"10th_percentile":16590.72,"90th_percentile":49976.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12333.26,"10th_percentile":12333.26,"90th_percentile":12333.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":42097.39,"10th_percentile":42097.39,"90th_percentile":42097.39},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":22505.85,"10th_percentile":18219.0,"90th_percentile":24790.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":19628.8,"10th_percentile":19628.8,"90th_percentile":19628.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12449.16,"10th_percentile":12442.67,"90th_percentile":12483.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12392.67,"10th_percentile":12392.67,"90th_percentile":12392.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19276.89,"maximum":44446.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19706.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20240.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44446.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37779.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19662.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35556.99},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19855.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34633.06},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34439.89},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29273.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20047.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":51153.41,"10th_percentile":51153.41,"90th_percentile":51153.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":46931.5,"10th_percentile":10171.77,"90th_percentile":58898.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":47790.86,"10th_percentile":47790.86,"90th_percentile":47790.86},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":21862.7,"10th_percentile":21862.7,"90th_percentile":21862.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19093.27,"10th_percentile":12483.3,"90th_percentile":19126.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19052.48,"10th_percentile":19052.48,"90th_percentile":19052.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17185.1,"maximum":39292.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17421.59},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39292.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33398.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17528.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31433.86},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17700.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30617.06},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30446.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25878.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17185.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17872.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30827.15,"maximum":72904.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32324.78},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32368.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":72904.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61969.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31443.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58323.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31751.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56808.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32985.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32985.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56491.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48016.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30827.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32060.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17297.15,"maximum":39568.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17543.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18162.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39568.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33633.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17643.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31654.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17816.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30832.18},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18507.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18507.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30660.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26060.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17297.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17989.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45569.79,"maximum":109228.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48430.32},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47848.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":109228.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92844.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46481.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87383.06},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46936.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":85112.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48759.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48759.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84637.72},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71940.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45569.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47392.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4940.45,"maximum":11142.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4940.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6048.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11142.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9471.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5875.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8914.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8682.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6163.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6163.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8634.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7338.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5760.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5990.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5222.16,"10th_percentile":5222.16,"90th_percentile":5222.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6977.18,"maximum":15736.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6977.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8005.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15736.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13375.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12588.96},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12261.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8158.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8158.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12193.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10364.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":8394.14,"10th_percentile":8394.14,"90th_percentile":8394.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1727.06,"10th_percentile":1727.06,"90th_percentile":1727.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6998.46,"10th_percentile":6998.46,"90th_percentile":6998.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1980.0,"10th_percentile":251.28,"90th_percentile":7371.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15062.81,"maximum":34063.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15103.1},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34063.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28953.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15364.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27250.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15514.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26542.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16117.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16117.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26394.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22434.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15062.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15665.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":13330.3,"10th_percentile":13330.3,"90th_percentile":13330.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14360.86,"10th_percentile":14360.86,"90th_percentile":14360.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14491.29,"10th_percentile":9317.2,"90th_percentile":14692.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15402.25,"10th_percentile":15402.25,"90th_percentile":15402.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5214.96,"maximum":11761.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5214.96},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6312.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11761.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9997.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9409.38},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9164.88},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9113.76},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7746.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6011.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6251.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":1212.5,"10th_percentile":1212.5,"90th_percentile":1212.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":5315.84,"10th_percentile":5315.84,"90th_percentile":11820.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":13017.49,"10th_percentile":13017.49,"90th_percentile":13017.49},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":7247.31,"10th_percentile":7247.31,"90th_percentile":7247.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5469.94,"10th_percentile":250.08,"90th_percentile":5838.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5398.99,"10th_percentile":5398.99,"90th_percentile":6088.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6313.0,"maximum":14238.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6313.0},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7367.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14238.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12102.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11390.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11094.6},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11032.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9377.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7016.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":11667.96,"10th_percentile":11667.96,"90th_percentile":11667.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6393.73,"10th_percentile":6393.73,"90th_percentile":6825.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6461.12,"10th_percentile":251.28,"90th_percentile":6764.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5083.86,"maximum":11466.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5083.86},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11466.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9746.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9172.84},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8934.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6303.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6303.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8884.65},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7551.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5891.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6127.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5351.13,"10th_percentile":5351.13,"90th_percentile":5351.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4100.26,"maximum":9247.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4100.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5240.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9247.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7860.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7398.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7205.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5340.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5340.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7165.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6090.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4991.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5190.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":12406.0,"10th_percentile":11966.82,"90th_percentile":16298.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":9033.66,"10th_percentile":9033.66,"90th_percentile":9033.66},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1780.0,"10th_percentile":251.28,"90th_percentile":4850.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5328.68,"maximum":12018.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5328.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6421.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12018.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10215.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6237.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9614.55},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9364.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9312.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7915.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6360.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":8632.33,"10th_percentile":8632.33,"90th_percentile":8632.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10062.68,"10th_percentile":10062.68,"90th_percentile":24969.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5557.8,"10th_percentile":5549.45,"90th_percentile":5572.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":13220.92,"10th_percentile":13220.92,"90th_percentile":13220.92},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":9793.13,"10th_percentile":9793.13,"90th_percentile":9793.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":5613.38,"10th_percentile":251.28,"90th_percentile":5917.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4264.21,"10th_percentile":4264.21,"90th_percentile":4264.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8720.57,"maximum":19668.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8720.57},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19668.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16717.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9404.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15734.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9496.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15325.72},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15240.23},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12953.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9589.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":16244.61,"10th_percentile":16244.61,"90th_percentile":16244.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8777.94,"10th_percentile":8777.94,"90th_percentile":8813.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":16551.49,"10th_percentile":16551.49,"90th_percentile":16551.49},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":15915.28,"10th_percentile":15915.28,"90th_percentile":15915.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":31117.75,"10th_percentile":31117.75,"90th_percentile":31117.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":8597.81,"10th_percentile":1765.6,"90th_percentile":8905.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8615.36,"10th_percentile":8615.36,"90th_percentile":8615.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6614.31,"maximum":14917.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6614.31},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7656.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14917.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12680.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11934.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11624.12},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11559.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9825.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11413.52,"maximum":25741.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11413.52},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12269.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25741.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21880.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20593.47},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12036.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20058.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12503.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12503.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19946.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16954.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11685.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12152.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10505.0,"10th_percentile":10505.0,"90th_percentile":10505.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5469.19,"maximum":12335.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5469.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6556.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12335.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10484.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9868.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6431.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9611.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9558.06},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8124.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6493.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10181.59,"10th_percentile":6391.31,"90th_percentile":16787.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":19275.02,"10th_percentile":19275.02,"90th_percentile":19275.02},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":3067.78,"10th_percentile":3067.78,"90th_percentile":3067.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5713.1,"10th_percentile":251.28,"90th_percentile":6036.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6339.93,"10th_percentile":6339.93,"90th_percentile":6339.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8619.17,"maximum":19439.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8619.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9583.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19439.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16523.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9310.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15551.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9401.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15147.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9766.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15063.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12803.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9127.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9492.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8425.49,"10th_percentile":8419.49,"90th_percentile":8815.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8810.78,"10th_percentile":8810.78,"90th_percentile":8810.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48512.88,"maximum":116480.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51645.49},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50938.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":116480.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99008.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49483.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93184.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49968.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":90762.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90256.6},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76715.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48512.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50453.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23062.0,"maximum":53772.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23841.78},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24215.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53772.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45706.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23523.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43017.84},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23753.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41900.05},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24676.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24676.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41666.34},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35415.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23062.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23984.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":67775.45,"10th_percentile":67775.45,"90th_percentile":67775.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22114.22,"10th_percentile":20847.09,"90th_percentile":22163.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28590.16,"maximum":67393.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29881.0},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30019.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":67393.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57284.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29161.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53914.43},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29447.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52513.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30591.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30591.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52220.58},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44386.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28590.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29733.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25895.58,"10th_percentile":25895.58,"90th_percentile":25895.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18164.36,"maximum":41705.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18491.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19072.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41705.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35449.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18527.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33364.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18709.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32497.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19435.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19435.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32315.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27467.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18164.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18890.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":79589.9,"10th_percentile":79589.9,"90th_percentile":79589.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17459.94,"10th_percentile":17459.94,"90th_percentile":17459.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24816.32,"maximum":58094.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25758.28},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26057.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58094.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49380.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25312.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46475.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25560.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45268.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26553.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26553.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45015.65},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38262.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24816.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25808.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23604.43,"10th_percentile":23604.43,"90th_percentile":23604.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":68632.57,"10th_percentile":68632.57,"90th_percentile":68632.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22923.3,"10th_percentile":22922.3,"90th_percentile":23799.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22127.81,"10th_percentile":22127.81,"90th_percentile":22127.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36220.05,"maximum":86192.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38216.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38031.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":86192.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73263.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36944.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68953.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37306.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":67162.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38755.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38755.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66787.41},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56767.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36220.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37668.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":95134.28,"10th_percentile":95134.28,"90th_percentile":95134.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33691.08,"10th_percentile":281.03,"90th_percentile":34708.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35426.14,"10th_percentile":35426.14,"90th_percentile":35426.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29237.92,"maximum":68989.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30588.64},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30699.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68989.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58640.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29822.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55191.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53757.11},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31284.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31284.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53457.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45437.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29237.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30407.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27456.3,"10th_percentile":2793.56,"90th_percentile":27495.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38964.98,"10th_percentile":38964.98,"90th_percentile":38964.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46838.78,"maximum":112355.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49816.63},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49180.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":112355.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95502.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47775.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89884.39},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48243.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":87548.79},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50117.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50117.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87060.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73999.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46838.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48712.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32802.25,"maximum":77771.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34482.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34442.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":77771.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66105.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33458.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62216.9},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33786.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":60600.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35098.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35098.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60262.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51221.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32802.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34114.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":112839.39,"10th_percentile":112839.39,"90th_percentile":112839.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31001.15,"10th_percentile":30984.38,"90th_percentile":31443.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41869.54,"maximum":100111.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44388.0},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43963.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":100111.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85095.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42706.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80089.49},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43125.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":78008.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44800.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44800.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77573.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65935.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41869.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43544.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39168.83,"10th_percentile":39168.83,"90th_percentile":39168.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25226.72,"maximum":59105.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26206.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26488.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59105.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50240.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25731.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47284.74},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25983.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46056.07},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26992.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26992.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45799.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38928.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25226.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26235.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23386.21,"maximum":54571.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24195.97},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24555.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54571.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46385.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23853.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43656.9},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24087.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42522.5},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25023.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25023.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42285.31},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35941.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23386.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24321.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23009.79,"10th_percentile":23009.79,"90th_percentile":23009.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56408.24,"10th_percentile":56408.24,"90th_percentile":56408.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21508.57,"maximum":49944.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22144.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22584.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49944.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42453.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21938.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39955.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22153.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38917.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23014.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23014.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38700.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32894.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21508.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22368.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11805.37,"maximum":26625.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11805.37},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12646.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26625.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22631.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21300.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12405.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20747.0},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20631.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17536.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12044.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12525.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13692.89,"maximum":30882.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13692.89},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14460.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30882.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26250.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14047.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24706.15},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14185.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24064.17},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23929.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20339.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22804.09,"maximum":53136.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23560.03},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23944.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53136.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45166.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23260.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42509.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23488.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41404.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24400.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24400.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41173.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34996.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23716.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21907.56,"10th_percentile":21907.56,"90th_percentile":21907.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14644.45,"maximum":33032.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14646.07},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15376.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33032.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28077.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14937.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26425.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25739.31},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25595.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21755.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14644.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15230.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22070.14,"maximum":51328.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22758.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23173.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51328.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43629.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22511.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41062.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22732.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39995.79},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23615.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23615.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39772.7},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33805.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22070.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22952.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7910.8,"maximum":17841.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7910.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17841.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15165.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8648.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14273.5},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13902.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9072.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9072.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13825.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11750.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8479.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8818.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12297.89,"maximum":27736.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12297.89},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13119.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27736.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23575.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12744.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22189.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12869.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21612.57},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13369.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13369.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21492.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18267.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12494.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12994.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19121.74,"maximum":44064.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19537.27},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20077.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44064.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37454.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19504.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35251.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19695.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34335.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34143.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29021.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19121.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19886.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12904.85,"maximum":29105.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12904.85},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13703.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29105.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24739.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13311.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23284.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13442.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22679.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13964.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13964.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22552.76},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19169.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13050.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17214.08,"10th_percentile":17214.08,"90th_percentile":17214.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18446.8,"maximum":42401.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18799.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19369.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42401.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36040.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18815.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33920.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19000.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33039.39},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19738.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19738.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32855.1},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27926.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18446.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19184.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":38175.23,"10th_percentile":38175.23,"90th_percentile":38175.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":86936.83,"10th_percentile":86936.83,"90th_percentile":86936.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17730.15,"10th_percentile":17730.15,"90th_percentile":17730.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16422.13,"10th_percentile":16422.13,"90th_percentile":16422.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24365.47,"maximum":56983.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25265.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25583.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56983.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48436.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24852.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45587.13},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25096.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44402.57},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26071.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26071.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44154.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37530.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24365.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25340.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22786.92,"10th_percentile":251.28,"90th_percentile":23381.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23942.6,"10th_percentile":23942.6,"90th_percentile":23942.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10824.66,"maximum":24413.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10824.66},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11703.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24413.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20751.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11369.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19530.99},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11480.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19023.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11926.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11926.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18917.38},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16079.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11146.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":51223.3,"10th_percentile":51223.3,"90th_percentile":51223.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15707.92,"maximum":35652.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15807.85},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16493.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35652.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30304.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16022.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28522.18},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16179.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27781.04},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16807.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16807.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27626.09},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23481.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15707.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16336.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":2565.5,"10th_percentile":2565.5,"90th_percentile":2565.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31486.84,"maximum":74530.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33045.46},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33061.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":74530.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63350.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32116.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59624.09},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58074.79},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33690.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33690.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57750.86},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49086.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31486.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32746.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32180.52,"10th_percentile":32180.52,"90th_percentile":32180.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13091.72,"maximum":29526.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13091.72},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13882.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29526.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25097.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13486.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23621.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13618.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23007.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14147.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14147.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22879.34},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19446.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13221.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13750.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12355.01,"10th_percentile":12355.01,"90th_percentile":12355.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":34398.54,"10th_percentile":34398.54,"90th_percentile":34398.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12427.34,"10th_percentile":12427.34,"90th_percentile":12427.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15365.8,"maximum":34809.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15434.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16134.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34809.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29588.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27847.84},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15826.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27124.23},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16441.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16441.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26972.93},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22926.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15365.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15980.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15317.05,"10th_percentile":15289.29,"90th_percentile":15333.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22406.28,"maximum":52156.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23125.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23526.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52156.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44333.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22854.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41725.36},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23078.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40641.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40414.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34351.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22406.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23302.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27143.65,"10th_percentile":27143.65,"90th_percentile":27143.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22614.46,"10th_percentile":22580.25,"90th_percentile":22629.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10027.21,"maximum":22615.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10027.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22615.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19222.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18092.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10728.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17622.03},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11145.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11145.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17523.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14894.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10833.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20136.81,"maximum":46565.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20646.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46565.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39580.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20539.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37251.99},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20740.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36284.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21546.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21546.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36081.63},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30668.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20136.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20942.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":102485.66,"10th_percentile":102485.66,"90th_percentile":102485.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19525.24,"10th_percentile":19363.38,"90th_percentile":40901.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33869.03,"maximum":80399.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35647.87},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35562.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":80399.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68339.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34546.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64319.63},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34885.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":62648.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36239.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36239.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62298.88},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52952.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33869.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35223.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":4484.73,"10th_percentile":4484.73,"90th_percentile":4484.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32716.83,"10th_percentile":32716.83,"90th_percentile":32716.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23694.18,"10th_percentile":15453.64,"90th_percentile":32500.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29009.84,"maximum":68427.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30339.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30460.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68427.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58163.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29590.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54741.67},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29880.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53319.24},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31040.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31040.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53021.83},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45067.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29009.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30170.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40147.05,"maximum":95867.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42506.27},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42154.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":95867.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81487.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40949.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76694.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41351.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":74701.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42957.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42957.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74284.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63140.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40147.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41752.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3011.78,"10th_percentile":3011.78,"90th_percentile":3011.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71119.11,"10th_percentile":71119.11,"90th_percentile":71119.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":28925.48,"10th_percentile":28925.48,"90th_percentile":28925.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37455.9,"maximum":89237.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39566.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39328.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":89237.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75851.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38205.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71389.73},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38579.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":69534.71},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40077.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40077.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69146.86},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58773.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37455.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38954.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":111094.19,"10th_percentile":111094.19,"90th_percentile":111094.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35560.51,"10th_percentile":35560.51,"90th_percentile":35560.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":132998.84,"10th_percentile":132998.84,"90th_percentile":132998.84},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34899.69,"10th_percentile":34899.69,"90th_percentile":34899.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51926.04,"maximum":124889.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55374.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54522.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":124889.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106156.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52964.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99911.91},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53483.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":97315.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55560.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55560.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96772.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82254.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51926.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54003.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":149265.71,"10th_percentile":149265.71,"90th_percentile":149265.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2628.63,"10th_percentile":2628.63,"90th_percentile":2628.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":185138.66,"10th_percentile":185138.66,"90th_percentile":185138.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2450.0,"10th_percentile":2450.0,"90th_percentile":2450.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38659.46,"10th_percentile":38659.46,"90th_percentile":38659.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41433.28,"maximum":99037.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43911.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":99037.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84181.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79229.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42676.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":77170.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44333.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44333.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76740.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65227.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41433.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43090.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":122435.48,"10th_percentile":122435.48,"90th_percentile":122435.48},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57128.67,"maximum":137708.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61057.77},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59985.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":137708.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117052.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58271.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110166.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58842.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":107304.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61127.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61127.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106705.67},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90697.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57128.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59413.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22119.2,"maximum":51449.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22811.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23225.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51449.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43731.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22561.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41159.49},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22782.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40089.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23667.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39866.37},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33885.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23003.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20794.34,"10th_percentile":20794.34,"90th_percentile":20794.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34039.42,"maximum":80819.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35834.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35741.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":80819.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68696.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34720.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64655.49},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35060.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":62975.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62624.19},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53229.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34039.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35401.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":32459.36,"10th_percentile":32459.36,"90th_percentile":32459.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32734.98,"10th_percentile":32734.98,"90th_percentile":32734.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34654.69,"maximum":82335.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36506.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36387.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":82335.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69985.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65868.26},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35694.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":64156.71},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37080.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37080.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63798.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54227.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34654.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36040.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36594.65,"maximum":87115.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38625.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38424.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":87115.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74047.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37326.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69692.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37692.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":67881.21},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39156.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39156.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67502.58},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57375.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36594.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38058.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52145.5,"maximum":125430.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55613.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54752.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":125430.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106616.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53188.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100344.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53709.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":97737.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55795.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55795.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97191.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82610.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52145.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54231.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44832.52,"maximum":107412.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47624.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47074.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":107412.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91300.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45729.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85929.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46177.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":83696.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47970.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47970.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83230.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70743.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44832.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46625.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44832.52,"maximum":107412.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47624.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47074.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":107412.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91300.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45729.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85929.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46177.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":83696.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47970.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47970.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83230.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70743.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44832.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46625.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1946.57,"10th_percentile":1946.57,"90th_percentile":1946.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66098.5,"maximum":159809.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70856.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69403.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":159809.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":135837.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67420.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":127847.3},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68081.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":124525.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70725.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70725.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123830.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105253.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66098.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68742.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62639.11,"10th_percentile":62639.11,"90th_percentile":62639.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67253.46,"maximum":162654.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72118.55},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70616.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":162654.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":138256.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68598.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":130123.85},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69271.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":126742.65},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71961.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71961.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126035.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107127.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67253.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69943.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":168732.54,"10th_percentile":168732.54,"90th_percentile":168732.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70055.4,"10th_percentile":70055.4,"90th_percentile":70055.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39074.96,"maximum":93226.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41335.08},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41028.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":93226.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79242.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39856.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74581.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40247.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":72643.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41810.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41810.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72237.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61400.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39074.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40637.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73333.9,"maximum":177636.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78761.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77000.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":177636.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":150990.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74800.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":142109.05},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75533.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":138416.42},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78467.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78467.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137644.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116994.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73333.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76267.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76282.3,"maximum":184900.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81982.07},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80096.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":184900.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":157165.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77807.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":147920.64},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78570.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":144077.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81622.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81622.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143273.37},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":121778.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76282.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79333.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19461.87,"maximum":44902.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19908.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20434.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44902.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38166.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19851.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35921.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20045.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34988.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20824.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20824.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34793.04},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29573.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19461.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20240.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":45537.58,"10th_percentile":45537.58,"90th_percentile":45537.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":34177.26,"10th_percentile":34177.26,"90th_percentile":34177.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":4750.85,"10th_percentile":4750.85,"90th_percentile":4750.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":18668.37,"10th_percentile":18050.69,"90th_percentile":18715.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16976.17,"10th_percentile":16976.17,"90th_percentile":17043.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43900.33,"maximum":105115.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46606.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46095.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":105115.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89348.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44778.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84092.39},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45217.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":81907.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46973.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46973.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81450.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69230.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43900.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45656.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":84128.33,"10th_percentile":84128.33,"90th_percentile":84128.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42216.09,"10th_percentile":30665.1,"90th_percentile":63471.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6816.39,"maximum":15373.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6816.39},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7851.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15373.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13067.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7626.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12298.84},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11979.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8000.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8000.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11912.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10125.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13261.93,"maximum":29910.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13261.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14046.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29910.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25424.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13644.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23928.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13778.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23306.8},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14313.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14313.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23176.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19699.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13912.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12964.21,"10th_percentile":8968.38,"90th_percentile":12992.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10317.08,"10th_percentile":10317.08,"90th_percentile":10317.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5848.0,"maximum":13189.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5848.0},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6920.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13189.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11211.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6722.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10551.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10277.39},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10220.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8686.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6590.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6854.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4852.81,"maximum":10944.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4852.81},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5963.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10944.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9303.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5793.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8755.95},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5850.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8528.43},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6077.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6077.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8480.86},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7208.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5215.22,"10th_percentile":5215.22,"90th_percentile":5215.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7034.4,"maximum":15865.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7034.4},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8060.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15865.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13485.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12692.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12362.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12293.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10449.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7676.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7983.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7335.16,"10th_percentile":7335.16,"90th_percentile":7335.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7534.68,"10th_percentile":7534.68,"90th_percentile":7534.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7081.86,"10th_percentile":740.0,"90th_percentile":7107.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6726.32,"10th_percentile":6726.32,"90th_percentile":6726.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5179.47,"maximum":11681.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5179.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6277.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11681.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9929.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6098.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9345.34},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6158.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9102.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6397.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6397.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9051.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7693.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5978.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6218.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7962.23,"maximum":17957.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7962.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8952.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17957.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15264.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8696.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14366.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8782.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13992.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9123.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9123.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13914.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11827.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8526.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8867.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12777.38,"maximum":28817.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12777.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13580.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28817.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24495.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13192.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23054.28},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22455.23},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13839.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13839.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22329.98},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18979.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12933.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5187.44,"maximum":11699.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5187.44},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6285.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11699.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9944.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9359.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6165.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9116.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6405.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6405.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9065.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7705.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5986.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6874.33,"maximum":15504.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6874.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15504.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13178.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7680.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12403.39},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7756.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12081.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8057.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8057.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12013.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10211.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7530.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7831.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13668.99,"maximum":30828.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13668.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14437.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30828.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26204.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14025.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24663.02},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14162.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24022.17},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14712.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14712.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23888.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20304.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13750.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14300.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":23291.98,"10th_percentile":23291.98,"90th_percentile":23291.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.23,"maximum":10267.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5675.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10267.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8726.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5512.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8213.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8000.18},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7955.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6762.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5404.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5837.13,"maximum":13164.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5837.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6910.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13164.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11190.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10531.97},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6778.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10258.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10201.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8670.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6580.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6844.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":11109.9,"10th_percentile":11109.9,"90th_percentile":11109.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6169.55,"10th_percentile":670.0,"90th_percentile":6383.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6440.42,"10th_percentile":6440.42,"90th_percentile":6440.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9520.2,"maximum":21471.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9520.2},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10449.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21471.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18250.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17177.34},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16731.0},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16637.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14141.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10350.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":6808.18,"10th_percentile":6808.18,"90th_percentile":6808.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":19751.38,"10th_percentile":19751.38,"90th_percentile":34470.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9206.65,"10th_percentile":9206.65,"90th_percentile":9206.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":16152.29,"10th_percentile":16152.29,"90th_percentile":16152.29},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"32","median_amount":9325.05,"10th_percentile":1980.0,"90th_percentile":9605.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9769.43,"10th_percentile":9769.43,"90th_percentile":9769.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4650.01,"maximum":10487.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4650.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10487.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8914.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5604.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8390.03},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5659.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8172.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5878.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5878.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8126.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6907.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5714.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2000.0,"10th_percentile":2000.0,"90th_percentile":5338.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3289.1,"10th_percentile":3289.1,"90th_percentile":3289.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6105.85,"maximum":13771.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6105.85},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13771.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11705.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6963.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11016.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7031.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10730.55},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7304.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7304.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10670.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9069.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6826.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7100.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":16930.66,"10th_percentile":16930.66,"90th_percentile":16930.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6413.14,"10th_percentile":251.58,"90th_percentile":8089.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6908.27,"10th_percentile":6908.27,"90th_percentile":6908.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8023.07,"maximum":18095.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8023.07},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9011.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18095.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15380.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8753.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14476.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14099.91},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9182.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14021.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11917.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8925.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":14890.66,"10th_percentile":14890.66,"90th_percentile":14890.66},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":8067.58,"10th_percentile":1005.0,"90th_percentile":8301.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8476.74,"10th_percentile":8476.74,"90th_percentile":8476.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8948.0,"maximum":20181.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8948.0},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9900.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20181.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17153.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9617.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16144.92},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9711.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15725.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15637.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13291.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9428.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":17126.08,"10th_percentile":17126.08,"90th_percentile":28077.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8975.22,"10th_percentile":8975.22,"90th_percentile":8975.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":17298.61,"10th_percentile":17298.61,"90th_percentile":17298.61},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":13628.54,"10th_percentile":13628.54,"90th_percentile":13628.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":25496.21,"10th_percentile":25496.21,"90th_percentile":25496.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":8798.58,"10th_percentile":1792.89,"90th_percentile":8839.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7663.8,"10th_percentile":7663.8,"90th_percentile":9371.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5194.68,"maximum":11715.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5194.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6292.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11715.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9958.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6112.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9372.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6172.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9129.24},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9078.32},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7716.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5992.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6232.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7164.05,"maximum":16157.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7164.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16157.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13734.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7951.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12926.13},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8029.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12590.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12520.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10641.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8107.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5409.91,"10th_percentile":5409.91,"90th_percentile":5409.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11288.22,"maximum":25459.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11288.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12149.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25459.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21640.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20367.38},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19838.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12380.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12380.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19727.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16767.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11570.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11124.46,"10th_percentile":11124.46,"90th_percentile":11124.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5696.62,"maximum":12848.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5696.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12848.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10920.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10278.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6645.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10011.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6903.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6903.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9955.52},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8461.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6710.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7707.28,"maximum":17382.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7707.28},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17382.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14775.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13906.28},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8541.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13544.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13469.38},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11448.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8292.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8624.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":9744.94,"10th_percentile":9744.94,"90th_percentile":9744.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11081.07,"maximum":24992.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11081.07},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24992.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21243.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19993.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11722.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19474.1},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19365.47},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16460.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5459.77,"maximum":12313.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5459.77},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6547.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12313.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10466.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6360.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9851.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9595.12},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6672.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9541.6},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8110.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9209.47,"maximum":20770.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9209.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20770.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17655.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9861.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16616.7},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9957.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16184.92},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10344.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10344.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16094.65},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13680.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9667.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9239.61,"10th_percentile":9239.61,"90th_percentile":9239.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15276.3,"maximum":34589.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15336.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34589.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29400.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15581.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27671.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26952.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16345.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16345.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26802.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22781.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15276.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15887.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15564.93,"10th_percentile":15564.93,"90th_percentile":15564.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8708.26,"maximum":19640.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8708.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19640.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16694.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15712.35},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9485.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15304.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9853.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9853.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15218.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12935.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9209.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12551.39,"maximum":28308.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12551.39},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28308.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24061.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12981.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22646.54},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13108.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22058.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13617.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13617.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21935.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18644.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12727.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13236.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26078.02,"maximum":61203.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27136.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27381.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61203.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52022.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26599.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48962.74},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26860.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47690.47},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27903.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27903.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47424.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40309.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26078.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27121.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11562.73,"maximum":26078.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11562.73},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12413.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26078.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22166.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12058.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20862.68},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12176.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20320.58},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12649.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12649.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20207.23},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17175.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11822.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12294.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15698.63,"maximum":35629.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15797.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16483.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35629.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30285.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16012.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28503.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16169.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27763.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16797.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16797.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27608.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23466.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15698.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29517.04,"maximum":69676.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30893.57},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30992.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":69676.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59225.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30107.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55741.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54293.0},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31583.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31583.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53990.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45890.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29517.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30697.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8950.18,"maximum":20186.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8950.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9902.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20186.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17158.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16148.84},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15729.23},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10090.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10090.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15641.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13294.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9807.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6418.75,"maximum":14476.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6418.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7469.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14476.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12305.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11581.38},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7326.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11280.44},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7611.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7611.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11217.52},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9534.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10815.25,"maximum":24392.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10815.25},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11694.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24392.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20733.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11360.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19514.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11471.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19006.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18900.93},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16065.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11137.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11583.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7353.82,"maximum":16585.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7353.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8367.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16585.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14097.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8128.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13268.53},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8208.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12923.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12851.67},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10923.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7969.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15625.04,"maximum":35448.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15717.31},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16406.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35448.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30131.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15937.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28358.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16093.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27621.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27467.86},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23347.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15625.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5561.18,"maximum":12542.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5561.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6644.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12542.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10661.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6454.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10034.06},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9773.33},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6771.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6771.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9718.81},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8260.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9583.21,"maximum":21613.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9583.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10510.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21613.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18371.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17291.04},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16841.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10710.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10710.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16747.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14235.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5784.26,"maximum":13045.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5784.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13045.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11088.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6663.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10436.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6728.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10165.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10108.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8592.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6532.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6793.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6293.07,"10th_percentile":6293.07,"90th_percentile":6293.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5691.55,"maximum":12836.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5691.55},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12836.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10911.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6576.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10269.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6641.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10002.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6899.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6899.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9946.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8454.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6447.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6705.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8425.78,"maximum":19003.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8425.78},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9398.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19003.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16152.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9129.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15202.68},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14807.65},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14725.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12515.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7857.93,"maximum":17722.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7857.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17722.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15064.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14178.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8683.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13809.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13732.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11672.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13096.07,"maximum":29536.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13096.07},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13886.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29536.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25106.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23629.3},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23015.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22886.93},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19453.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13225.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13754.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11117.28,"maximum":25073.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11117.28},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25073.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21312.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20058.96},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19537.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19428.76},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16513.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11414.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9799.78,"maximum":22102.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9799.78},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10718.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22102.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18786.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10412.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17681.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10514.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17222.34},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10922.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10922.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17126.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14556.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16825.75,"maximum":38406.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17029.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17667.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38406.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32645.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17162.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30725.54},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17330.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29927.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18003.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18003.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29760.22},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25295.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16825.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17498.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6057.32,"maximum":13661.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6057.32},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13661.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11612.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6918.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10929.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6985.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10645.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10585.89},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8997.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":11859.77,"10th_percentile":11859.77,"90th_percentile":11859.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":11382.85,"10th_percentile":4489.34,"90th_percentile":14576.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":18612.69,"10th_percentile":18612.69,"90th_percentile":18612.69},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":16659.14,"10th_percentile":16659.14,"90th_percentile":16659.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":1259.99,"10th_percentile":1259.99,"90th_percentile":1259.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6356.21,"10th_percentile":6356.21,"90th_percentile":6356.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8118.68,"maximum":18310.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8118.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18310.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15564.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8842.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14648.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8929.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14267.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9276.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9276.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14188.35},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12059.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8669.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9016.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6732.05,"10th_percentile":6732.05,"90th_percentile":6732.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6537.53,"maximum":14744.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6537.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7583.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14744.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12532.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7366.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11795.7},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11489.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7727.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7727.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11425.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9711.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7222.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7510.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":12290.88,"10th_percentile":12290.88,"90th_percentile":20426.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5284.66,"10th_percentile":5284.66,"90th_percentile":6666.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14028.24,"maximum":31639.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14028.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31639.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26893.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14360.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25311.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14501.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24653.53},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15064.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15064.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24516.01},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20838.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14642.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12328.14,"10th_percentile":12328.14,"90th_percentile":12328.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13528.59,"10th_percentile":13528.59,"90th_percentile":13571.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14271.87,"10th_percentile":14271.87,"90th_percentile":14271.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9867.86,"maximum":22255.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9867.86},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22255.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18917.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10476.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17804.63},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10578.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17341.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10989.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10989.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17245.26},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14658.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10270.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16453.14,"maximum":37488.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16621.96},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37488.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31865.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16782.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29991.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16946.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29211.78},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29048.84},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24690.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17111.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25184.29,"maximum":59001.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26160.27},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26443.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59001.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50151.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25687.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47201.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25939.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45974.6},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26947.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26947.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45718.16},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38859.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25184.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26191.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":769.57,"10th_percentile":769.57,"90th_percentile":769.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18338.07,"maximum":42133.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18681.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42133.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35813.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33706.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18888.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32830.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32647.51},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27749.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19071.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18338.07,"maximum":42133.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18681.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19254.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42133.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35813.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33706.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18888.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32830.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19621.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32647.51},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27749.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18338.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19071.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24571.67,"maximum":57491.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25491.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25800.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57491.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48868.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25063.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45993.56},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25308.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44798.44},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44548.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37865.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24571.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25554.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":18877.75,"10th_percentile":18877.75,"90th_percentile":18877.75},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5767.6,"maximum":13008.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5767.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6843.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13008.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11056.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10406.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10136.1},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10079.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8567.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6517.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6777.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7409.59,"maximum":16711.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7409.59},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16711.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14204.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13369.16},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13021.77},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12949.13},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11006.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":6570.71,"10th_percentile":6570.71,"90th_percentile":6570.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7663.29,"10th_percentile":251.58,"90th_percentile":7750.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5406.91,"10th_percentile":5406.91,"90th_percentile":5406.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12720.16,"maximum":28688.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12720.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13525.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28688.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24385.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22951.04},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13267.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22354.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22229.98},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18894.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12881.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13396.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":15621.8,"10th_percentile":15621.8,"90th_percentile":15621.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47636.67,"10th_percentile":47636.67,"90th_percentile":47636.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11377.0,"10th_percentile":11377.0,"90th_percentile":12550.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5962.44,"maximum":13447.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5962.44},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13447.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11430.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10758.06},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10478.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7164.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10420.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8856.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6695.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6963.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5816.91,"10th_percentile":5816.91,"90th_percentile":5816.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7957.16,"maximum":17946.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7957.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8947.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17946.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15254.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14357.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8777.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13984.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9118.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9118.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13906.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11819.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8521.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8862.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9791.09,"maximum":22082.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9791.09},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10710.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22082.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18770.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10404.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17666.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10506.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17207.06},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17111.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14544.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.58,"10th_percentile":251.58,"90th_percentile":251.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6625.17,"maximum":14942.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6625.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7667.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14942.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12700.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11953.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7521.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11643.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11578.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9841.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7302.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7594.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9435.46,"maximum":21280.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9435.46},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10368.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21280.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18088.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10072.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17024.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16582.07},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10566.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10566.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16489.58},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14015.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9874.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10269.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16300.64,"maximum":37113.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16455.37},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17115.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37113.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31546.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16626.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29690.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28919.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17441.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17441.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28757.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24443.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16952.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6922.86,"maximum":15613.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6922.86},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15613.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13271.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7726.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12490.95},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7802.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12166.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8105.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8105.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12098.52},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10283.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7574.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7877.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10109.78,"maximum":22801.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10109.78},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11016.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22801.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19381.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18241.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10806.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17767.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11226.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11226.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17668.04},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15017.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10492.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16391.48,"maximum":37336.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16554.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17211.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37336.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31736.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16719.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29869.55},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29093.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17538.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28931.12},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24590.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16391.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6486.83,"maximum":14630.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6486.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7534.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14630.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12435.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11704.22},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11400.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11336.5},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9635.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13109.83,"maximum":29567.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13109.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13900.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29567.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25132.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13502.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23654.13},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23039.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22910.98},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19473.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13767.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12374.84,"10th_percentile":12374.84,"90th_percentile":12374.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5976.92,"maximum":13480.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5976.92},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13480.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11458.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6843.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10784.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6910.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10503.97},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7178.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7178.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10445.38},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8878.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13888.45,"maximum":31323.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13888.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14648.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31323.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26625.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14229.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25059.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14369.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24407.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14927.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14927.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24271.72},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20630.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13950.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14508.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7466.08,"maximum":16838.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7466.08},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16838.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14313.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8233.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13471.09},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8314.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13121.05},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8637.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8637.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13047.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11090.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8072.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":19005.46,"10th_percentile":19005.46,"90th_percentile":19005.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":17793.86,"10th_percentile":17793.86,"90th_percentile":17793.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":13419.38,"10th_percentile":13419.38,"90th_percentile":13419.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7559.05,"10th_percentile":7382.8,"90th_percentile":7573.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11619.94,"maximum":26207.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11619.94},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12468.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26207.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22276.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12111.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20965.92},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12230.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20421.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12705.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12705.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20307.23},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17260.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11874.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12349.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11316.84,"10th_percentile":11316.84,"90th_percentile":11316.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5477.16,"maximum":12353.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5477.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6564.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12353.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10500.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6376.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9882.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6438.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9625.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9571.98},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8135.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6251.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10580.21,"10th_percentile":10580.21,"90th_percentile":10580.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.58,"10th_percentile":251.58,"90th_percentile":251.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7431.32,"maximum":16760.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7431.32},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16760.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14246.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13408.36},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13059.95},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8603.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8603.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12987.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11038.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8361.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7659.52,"10th_percentile":7659.52,"90th_percentile":7659.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":155626.45,"10th_percentile":155626.45,"90th_percentile":155626.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7631.59,"10th_percentile":7631.59,"90th_percentile":7662.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12058.15,"maximum":27195.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12058.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12889.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27195.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23116.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12521.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21756.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12643.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21191.24},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21073.04},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17911.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11720.86,"10th_percentile":11720.86,"90th_percentile":11720.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1850.0,"10th_percentile":1850.0,"90th_percentile":1850.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10604.39,"10th_percentile":10604.39,"90th_percentile":10625.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5785.71,"maximum":13048.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5785.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13048.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11091.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6664.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10439.18},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6729.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10167.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6991.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6991.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10111.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8594.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10792.35,"10th_percentile":10792.35,"90th_percentile":10792.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":12541.38,"10th_percentile":12541.38,"90th_percentile":12541.38},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":7563.72,"10th_percentile":7563.72,"90th_percentile":7563.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5891.48,"10th_percentile":5852.85,"90th_percentile":6027.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6260.85,"maximum":14120.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6260.85},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7317.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14120.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12002.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7108.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11296.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7177.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11002.95},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7456.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10941.58},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9300.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7247.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6724.62,"10th_percentile":6724.62,"90th_percentile":6724.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10637.79,"maximum":23992.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10637.79},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11524.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23992.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20393.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11194.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19193.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11304.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18695.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11743.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18590.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15801.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10975.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11414.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10471.08,"10th_percentile":10471.08,"90th_percentile":10471.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4957.11,"maximum":11180.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4957.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6064.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11180.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9503.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5890.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8944.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5948.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8711.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8663.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7363.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5775.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6006.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":15529.03,"10th_percentile":15529.03,"90th_percentile":15529.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":9289.78,"10th_percentile":9289.78,"90th_percentile":9289.78},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5319.52,"10th_percentile":5308.76,"90th_percentile":5601.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7317.6,"maximum":16503.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7317.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8332.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16503.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14028.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13203.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12860.11},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8491.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8491.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12788.38},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10869.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7936.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":8030.21,"10th_percentile":8030.21,"90th_percentile":8030.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":13734.0,"10th_percentile":13734.0,"90th_percentile":13734.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7591.76,"10th_percentile":7591.76,"90th_percentile":7591.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":13608.74,"10th_percentile":13608.74,"90th_percentile":13608.74},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":12126.53,"10th_percentile":12126.53,"90th_percentile":12126.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":7422.44,"10th_percentile":7388.94,"90th_percentile":7670.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5761.49,"10th_percentile":5761.49,"90th_percentile":5761.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14565.67,"maximum":32851.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14565.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15299.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32851.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27923.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14862.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26280.91},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25598.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15590.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25455.24},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21636.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14570.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15153.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":32720.47,"10th_percentile":32720.47,"90th_percentile":32720.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13948.69,"10th_percentile":13948.69,"90th_percentile":13948.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":28229.26,"10th_percentile":28229.26,"90th_percentile":28229.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13618.72,"10th_percentile":13613.91,"90th_percentile":13647.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5211.68,"10th_percentile":5211.68,"90th_percentile":14696.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10167.72,"maximum":22932.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10167.72},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22932.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19492.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10755.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18345.67},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10861.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17868.97},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11283.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11283.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17769.3},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15103.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10966.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12727.4,"maximum":28705.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12727.4},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13532.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28705.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24399.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13145.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22964.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13274.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22367.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13790.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13790.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22242.64},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18905.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12888.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13403.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":1879.86,"10th_percentile":1879.86,"90th_percentile":1879.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12409.52,"10th_percentile":12409.52,"90th_percentile":12409.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12126.83,"10th_percentile":12126.83,"90th_percentile":12126.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19517.56,"maximum":45039.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19969.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45039.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38283.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19907.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36031.38},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20103.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35095.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20883.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20883.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34899.37},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29663.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19517.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20298.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18739.99,"10th_percentile":18739.99,"90th_percentile":18739.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6662.11,"maximum":15025.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6662.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7702.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15025.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12771.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7482.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12020.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11708.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7849.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7849.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11642.83},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9896.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7629.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8987.84,"maximum":20271.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8987.84},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9938.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20271.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17230.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9654.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16216.8},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9748.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15795.42},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10127.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10127.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15707.31},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13350.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9843.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12381.91,"maximum":27925.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12381.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27925.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23737.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12823.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22340.74},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12949.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21760.23},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21638.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18392.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13074.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9384.03,"maximum":21164.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9384.03},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10319.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21164.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17989.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16931.65},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10122.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16491.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16399.7},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13939.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9827.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.58,"10th_percentile":251.58,"90th_percentile":7046.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7991.47,"10th_percentile":7991.47,"90th_percentile":7991.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16640.1,"maximum":37949.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16826.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37949.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32257.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30359.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29570.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17804.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17804.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29405.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24994.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16640.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17305.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8895.1,"10th_percentile":8895.1,"90th_percentile":8895.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16948.21,"10th_percentile":16948.21,"90th_percentile":16948.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11108.18,"10th_percentile":11108.18,"90th_percentile":11108.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7384.96,"maximum":16655.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7384.96},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16655.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14157.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8157.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13324.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8237.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12978.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8557.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8557.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12906.1},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10969.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7997.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8317.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11059.34,"maximum":24943.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11059.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24943.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21201.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11588.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19954.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11702.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19435.91},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12156.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12156.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19327.5},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16427.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11361.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11815.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":19910.52,"10th_percentile":19910.52,"90th_percentile":19910.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7092.35,"maximum":15995.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7092.35},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8116.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15995.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13596.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12796.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12464.24},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8271.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8271.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12394.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10535.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13119.25,"maximum":29588.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13119.25},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13909.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29588.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25150.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13511.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23671.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13644.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23056.04},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14174.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14174.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22927.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19487.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13246.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13776.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12513.73,"maximum":28223.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12513.73},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13327.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28223.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23989.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12946.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22578.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13073.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21991.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13581.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13581.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21869.23},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18588.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15815.32,"maximum":35917.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15925.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16606.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35917.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30529.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16131.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28733.89},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16289.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27987.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16922.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16922.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27831.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23655.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16447.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26837.83,"maximum":63075.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27966.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28179.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":63075.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53614.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27374.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50460.4},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27642.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49149.21},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28716.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28716.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48875.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41542.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26837.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27911.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8514.15,"maximum":19202.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8514.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9483.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19202.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16322.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15362.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9302.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14962.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14879.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12647.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":35441.08,"10th_percentile":35441.08,"90th_percentile":35441.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8598.86,"10th_percentile":8598.86,"90th_percentile":8598.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":19268.34,"10th_percentile":19268.34,"90th_percentile":55010.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":13573.04,"10th_percentile":13573.04,"90th_percentile":13573.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":14879.48,"10th_percentile":14879.48,"90th_percentile":14879.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8185.08,"10th_percentile":8158.41,"90th_percentile":8698.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11752.49,"maximum":26506.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11752.49},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12595.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26506.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22530.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12235.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21205.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12355.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20654.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20538.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17457.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11995.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12475.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10858.08,"10th_percentile":10858.08,"90th_percentile":10858.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10006.53,"10th_percentile":10006.53,"90th_percentile":10006.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23064.65,"maximum":53778.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23844.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24217.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53778.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45712.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23525.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43023.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41905.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24679.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24679.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41671.4},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35419.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23064.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23987.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22121.27,"10th_percentile":22121.27,"90th_percentile":22165.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38396.71,"maximum":91555.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40594.12},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40316.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":91555.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77821.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39164.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73244.16},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39548.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":71340.95},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41084.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41084.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70943.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60299.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38396.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39932.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":87098.61,"maximum":211550.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93798.3},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91453.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":211550.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":179818.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":169240.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89711.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":164843.1},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93195.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93195.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163923.63},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":139331.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87098.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90582.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31981.44,"maximum":75748.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33585.79},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33580.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":75748.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64386.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32621.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60599.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32940.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59024.37},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34220.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34220.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58695.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49889.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31981.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33260.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69597.19,"maximum":168429.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74678.95},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73077.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":168429.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":143165.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70989.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134743.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71685.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":131242.35},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74468.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74468.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130510.31},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110930.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69597.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72381.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":93073.63,"maximum":226272.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100325.69},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97727.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":226272.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":192331.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94935.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":181018.13},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95865.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":176314.47},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175331.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":149027.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93073.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96796.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":91148.0,"10th_percentile":91148.0,"90th_percentile":91301.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":141962.51,"maximum":346729.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153734.12},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149060.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":346729.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":294719.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144801.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":277383.22},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146221.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":270175.57},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151899.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151899.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":268668.58},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":228361.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141962.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147641.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1675.0,"10th_percentile":1675.0,"90th_percentile":1675.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76368.49,"maximum":185113.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82076.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80186.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":185113.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":157346.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77895.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":148090.53},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78659.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":144242.48},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81714.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81714.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143437.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":121918.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76368.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79423.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":187038.42,"maximum":457790.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":202977.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196390.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":457790.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":389122.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190779.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":366232.58},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192649.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":356716.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200131.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200131.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":354726.53},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":301509.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187038.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194519.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11460.6,"maximum":25848.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11460.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12314.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25848.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21970.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20678.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12080.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20141.1},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12549.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20028.75},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17023.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11728.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12197.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7071.34,"maximum":15948.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7071.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8096.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15948.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13556.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7864.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12758.85},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12427.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12358.01},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10504.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7710.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":13128.65,"10th_percentile":13128.65,"90th_percentile":13128.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4934.66,"maximum":11129.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4934.66},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11129.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9460.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8903.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5927.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8672.27},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6157.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6157.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8623.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7330.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5754.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5985.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":9243.83,"10th_percentile":9243.83,"90th_percentile":9243.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.28,"10th_percentile":251.28,"90th_percentile":251.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10696.46,"maximum":24124.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10696.46},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11580.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24124.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20505.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11249.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19299.68},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18798.19},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11801.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11801.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18693.33},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15888.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11029.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11470.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":24468.03,"10th_percentile":24468.03,"90th_percentile":24468.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10524.71,"10th_percentile":10524.71,"90th_percentile":10524.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10325.49,"10th_percentile":10325.49,"90th_percentile":10325.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5720.52,"maximum":12901.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5720.52},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12901.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10966.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6603.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10321.56},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6668.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10053.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9997.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8497.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5982.34,"10th_percentile":5982.34,"90th_percentile":5982.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":10991.89,"10th_percentile":10991.89,"90th_percentile":10991.89},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":5024.06,"10th_percentile":5024.06,"90th_percentile":5024.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6041.82,"10th_percentile":6011.87,"90th_percentile":6274.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4317.15,"10th_percentile":4317.15,"90th_percentile":4317.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3940.19,"maximum":8886.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3940.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5086.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8886.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7553.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4941.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7109.31},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4989.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":6924.58},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5183.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5183.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6885.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5852.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4844.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5038.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4710.88,"10th_percentile":4710.88,"90th_percentile":4710.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9186.3,"maximum":20718.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9186.3},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20718.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17610.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9839.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16574.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16144.19},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16054.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13645.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9646.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9047.22,"10th_percentile":9047.22,"90th_percentile":9047.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":9120.65,"10th_percentile":251.28,"90th_percentile":9149.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7656.71,"10th_percentile":7656.71,"90th_percentile":7656.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5646.64,"maximum":12735.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5646.64},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6726.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12735.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10825.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10188.26},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9923.53},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6855.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6855.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9868.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8387.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":9414.32,"10th_percentile":9414.32,"90th_percentile":9973.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10615.34,"10th_percentile":10615.34,"90th_percentile":13662.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5841.17,"10th_percentile":5841.17,"90th_percentile":5841.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":9934.4,"10th_percentile":9934.4,"90th_percentile":19894.23},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4080.13,"10th_percentile":4080.13,"90th_percentile":4080.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":10183.45,"10th_percentile":10183.45,"90th_percentile":10183.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":251.58,"10th_percentile":251.28,"90th_percentile":6205.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4864.25,"10th_percentile":4864.25,"90th_percentile":4873.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11583.73,"maximum":26125.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11583.73},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26125.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22206.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20900.58},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12196.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20357.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12670.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12670.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20243.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17206.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11841.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12314.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":21807.94,"10th_percentile":21807.94,"90th_percentile":21807.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11457.83,"10th_percentile":11457.83,"90th_percentile":11511.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6777.28,"maximum":15285.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6777.28},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15285.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12992.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7590.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12228.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7664.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11910.53},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7962.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7962.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11844.09},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10067.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7441.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7739.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":34331.34,"10th_percentile":34331.34,"90th_percentile":34331.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7115.76,"10th_percentile":7115.76,"90th_percentile":7115.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":8907.39,"10th_percentile":8907.39,"90th_percentile":8907.39},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.58,"10th_percentile":251.28,"90th_percentile":6933.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4700.71,"maximum":10601.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4700.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5817.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10601.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9011.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5651.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8481.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5706.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8261.12},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5928.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5928.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8215.04},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6982.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5540.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5762.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":3971.6,"10th_percentile":3971.6,"90th_percentile":3971.6},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1660.0,"10th_percentile":1660.0,"90th_percentile":1660.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17116.14,"maximum":39122.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17346.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17971.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39122.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33254.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17458.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31297.94},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17629.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30484.68},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18314.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18314.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30314.64},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25766.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17116.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17800.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10963.0,"maximum":24725.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10963.0},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24725.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21016.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19780.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11611.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19266.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19159.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16284.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11273.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11723.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8291.06,"maximum":18699.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8291.06},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9268.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18699.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15894.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14959.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9092.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14570.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9445.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9445.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14489.61},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12315.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8827.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9180.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7995.75,"10th_percentile":7995.75,"90th_percentile":7995.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":12315.83,"10th_percentile":12315.83,"90th_percentile":12315.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10589.13,"10th_percentile":10589.13,"90th_percentile":10589.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27894.0,"maximum":65677.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29120.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29288.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":65677.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55826.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28451.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52542.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28730.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51176.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29846.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29846.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50891.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43256.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27894.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29009.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37507.61,"maximum":89364.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39622.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39382.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":89364.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75959.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38257.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71491.67},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38632.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":69633.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40133.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40133.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69245.59},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58857.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37507.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39007.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20466.32,"maximum":47376.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21006.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21489.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47376.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40270.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20875.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37901.5},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21080.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36916.65},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21898.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21898.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36710.73},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31203.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20466.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21284.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15953.89,"maximum":36258.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16076.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16751.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36258.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30819.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16272.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29007.02},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28253.29},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28095.7},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23880.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15953.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16592.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24877.98,"maximum":58246.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25825.64},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26121.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58246.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49509.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25375.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46597.33},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25624.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45386.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26619.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45133.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38362.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24877.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25873.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15673.44,"maximum":35567.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15770.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16457.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35567.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30232.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15986.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28454.22},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27714.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16770.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16770.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27560.26},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23425.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16300.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11499.71,"maximum":25936.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11499.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12352.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25936.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22045.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11999.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20748.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20209.83},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20097.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17082.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11764.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23138.91,"maximum":53961.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23925.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24295.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53961.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45867.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23601.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43169.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23833.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42047.71},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24758.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41813.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35540.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23138.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24064.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15177.51,"maximum":34345.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15228.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15936.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34345.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29193.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15481.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27476.69},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15632.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26762.72},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16239.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16239.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26613.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22620.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15784.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12027.0,"maximum":27125.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12027.0},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27125.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23056.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12491.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21700.38},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12614.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21136.5},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13104.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13104.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21018.61},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17865.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12247.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12736.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24858.09,"maximum":58197.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25803.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26100.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58197.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49468.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25355.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46558.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25603.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45348.34},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26598.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26598.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45095.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38330.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24858.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25852.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23597.37,"10th_percentile":23597.37,"90th_percentile":23597.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14940.15,"maximum":33761.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14969.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15687.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33761.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28696.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15238.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27008.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15388.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26307.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15985.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15985.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26160.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22235.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14940.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14387.3,"10th_percentile":14387.3,"90th_percentile":14387.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9874.38,"maximum":22270.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9874.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10790.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22270.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18929.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17816.4},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10584.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17353.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10995.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10995.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17256.65},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14667.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10276.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":20445.03,"10th_percentile":20445.03,"90th_percentile":20445.03},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17059.79,"maximum":38983.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17284.7},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17912.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38983.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33136.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17400.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31186.86},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17571.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30376.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30207.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25675.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17059.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17742.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":31319.04,"10th_percentile":31319.04,"90th_percentile":31319.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":32828.3,"10th_percentile":32828.3,"90th_percentile":32828.3},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":25378.65,"10th_percentile":25378.65,"90th_percentile":25378.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16617.89,"10th_percentile":16617.89,"90th_percentile":16617.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12252.26,"maximum":27633.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12252.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13075.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27633.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23488.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12702.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22106.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21532.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21412.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18199.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12453.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12951.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":38844.45,"10th_percentile":22088.72,"90th_percentile":42062.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":14338.98,"10th_percentile":14338.98,"90th_percentile":14338.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9892.49,"maximum":22311.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9892.49},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10807.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22311.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18964.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10498.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17849.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17385.27},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17288.3},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14694.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":29867.34,"10th_percentile":29867.34,"90th_percentile":29867.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":15082.81,"10th_percentile":15082.81,"90th_percentile":15082.81},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":17106.6,"10th_percentile":17106.6,"90th_percentile":17106.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":238.32,"10th_percentile":238.32,"90th_percentile":238.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23827.11,"maximum":55657.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24677.63},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25018.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":55657.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47308.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24303.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44525.96},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24541.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43368.98},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25495.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25495.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43127.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36656.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23827.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24780.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12584.71,"maximum":28383.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12584.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28383.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24125.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13012.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22706.66},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13140.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22116.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13650.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13650.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21993.28},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18693.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12757.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13267.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10136.58,"maximum":22861.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10136.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22861.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19432.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10726.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18289.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10832.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17814.24},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11252.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11252.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17714.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15057.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10516.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28772.48,"maximum":67842.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30080.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30211.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":67842.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57665.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29347.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54273.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29635.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52863.54},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30786.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30786.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52568.67},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44682.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28772.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29923.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15743.72,"maximum":35740.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15846.96},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16530.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35740.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30379.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16058.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28592.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27849.78},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27694.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23539.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15743.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10866.67,"maximum":24508.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10866.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11744.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24508.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20832.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19606.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11520.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19097.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11967.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11967.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18990.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16141.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11184.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11632.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74309.19,"maximum":180039.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79826.55},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78024.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":180039.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":153033.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75795.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":144031.43},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76538.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":140288.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79510.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79510.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139506.35},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118577.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74309.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77281.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49097.65,"maximum":117921.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52284.32},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51552.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":117921.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100232.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50079.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94336.85},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50570.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":91885.56},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52534.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52534.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91373.04},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77664.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49097.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51061.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38512.07,"maximum":91839.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40720.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40437.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":91839.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78063.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39282.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73471.56},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39667.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":71562.44},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41207.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41207.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71163.28},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60487.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38512.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40052.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60972.12,"maximum":147178.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65256.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64020.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":147178.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":125101.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62191.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117742.68},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62801.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":114683.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65240.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65240.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114043.52},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96934.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60972.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63411.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39474.09,"maximum":94209.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41771.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41447.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":94209.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80078.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40263.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75367.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40658.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":73409.42},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42237.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42237.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72999.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62048.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39474.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41053.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14255.67,"maximum":32151.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14255.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15001.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32151.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27329.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14572.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25721.58},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25053.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15287.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15287.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24913.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21175.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13433.04,"10th_percentile":13415.4,"90th_percentile":13755.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24449.08,"10th_percentile":24449.08,"90th_percentile":24449.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7650.06,"maximum":17253.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7650.06},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8652.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17253.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14665.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8405.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13803.03},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8487.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13444.37},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13369.38},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11363.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8570.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":15766.52,"10th_percentile":15766.52,"90th_percentile":15766.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":13931.18,"10th_percentile":13931.18,"90th_percentile":13931.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7967.76,"10th_percentile":7967.76,"90th_percentile":7967.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5160.64,"maximum":11639.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5160.64},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6259.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11639.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9893.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9311.36},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6140.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9069.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9018.83},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7665.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6200.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5344.42,"10th_percentile":5344.42,"90th_percentile":5344.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13303.22,"maximum":30003.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13303.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30003.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25503.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13683.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24003.06},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23379.35},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23248.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19761.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13951.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12561.81,"10th_percentile":12561.81,"90th_percentile":12561.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8192.56,"maximum":18477.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8192.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9173.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18477.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15705.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14781.87},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8999.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14397.77},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14317.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12169.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8737.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9086.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6180.45,"maximum":13939.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6180.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13939.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11848.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11151.42},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7102.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10861.66},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7377.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7377.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10801.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9180.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6895.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7171.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11807.54,"maximum":26630.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11807.54},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12648.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26630.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22635.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21304.4},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12407.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20750.82},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12889.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12889.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20635.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17539.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12527.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":27801.68,"10th_percentile":27801.68,"90th_percentile":27801.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11455.83,"10th_percentile":11455.83,"90th_percentile":11455.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11530.97,"10th_percentile":11530.97,"90th_percentile":11565.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6092.81,"maximum":13741.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6092.81},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7155.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13741.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11680.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10993.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7019.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10707.63},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10647.91},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9050.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7087.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":7034.28,"10th_percentile":7034.28,"90th_percentile":7034.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":3879.4,"10th_percentile":3879.4,"90th_percentile":3879.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":11555.8,"10th_percentile":11555.8,"90th_percentile":25705.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":14852.37,"10th_percentile":14852.37,"90th_percentile":14852.37},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":4840.68,"10th_percentile":4840.68,"90th_percentile":4840.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6415.96,"10th_percentile":6415.96,"90th_percentile":6415.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6060.58,"10th_percentile":6060.58,"90th_percentile":6060.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4500.8,"maximum":10151.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4500.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5625.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10151.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8628.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8120.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5518.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7909.8},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5732.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5732.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7865.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6685.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3634.45,"10th_percentile":3634.45,"90th_percentile":3634.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":15808.02,"10th_percentile":15808.02,"90th_percentile":15808.02},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4852.17,"10th_percentile":4852.17,"90th_percentile":4852.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12999.01,"maximum":29317.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12999.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13793.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29317.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24920.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13399.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23454.18},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13530.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22844.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14056.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14056.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22717.31},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19309.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12993.52,"10th_percentile":12993.52,"90th_percentile":13015.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6991.67,"maximum":15768.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6991.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15768.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13403.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12615.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7866.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12287.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12218.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10385.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7943.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10589.42,"10th_percentile":10589.42,"90th_percentile":10589.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7101.24,"10th_percentile":7101.24,"90th_percentile":7101.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5226.36,"10th_percentile":5226.36,"90th_percentile":5226.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5067.93,"maximum":11430.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5067.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6170.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11430.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9715.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9144.09},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8906.48},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6288.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6288.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8856.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7528.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5876.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12102.33,"maximum":27295.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12102.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12931.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27295.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23201.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12562.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21836.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21268.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13178.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13178.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21150.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17977.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12315.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12808.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":58821.33,"10th_percentile":58821.33,"90th_percentile":58821.33},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11828.66,"10th_percentile":11828.66,"90th_percentile":11862.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7926.74,"maximum":17877.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7926.74},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8918.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17877.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15196.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8663.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14302.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13930.62},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9088.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9088.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13852.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11774.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8833.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":20690.12,"10th_percentile":20690.12,"90th_percentile":20690.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7853.25,"10th_percentile":7853.25,"90th_percentile":7853.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5992.13,"maximum":13514.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5992.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7058.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13514.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11487.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6857.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10811.64},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6924.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10530.7},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10471.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8900.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6722.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6991.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":38367.03,"10th_percentile":38367.03,"90th_percentile":38367.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5931.28,"10th_percentile":5931.28,"90th_percentile":5931.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":9205.66,"10th_percentile":9205.66,"90th_percentile":9205.66},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45537.3,"maximum":109148.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48394.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47814.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":109148.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92776.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46448.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87319.02},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46903.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":85050.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48724.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48724.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84575.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71887.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45537.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47358.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29354.61,"maximum":69276.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30716.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30822.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":69276.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58885.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29941.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55421.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53981.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31409.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31409.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53680.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45626.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29354.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30528.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4875.99,"maximum":10997.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4875.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5986.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10997.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9347.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5815.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8797.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5872.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8569.16},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8521.37},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7242.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5701.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5929.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":8892.51,"10th_percentile":8892.51,"90th_percentile":8892.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2302.39,"10th_percentile":251.58,"90th_percentile":5218.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8666.97,"maximum":19547.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8666.97},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9629.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19547.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16615.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9354.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15637.86},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9446.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15231.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9813.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9813.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15146.56},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12874.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9538.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5212.79,"maximum":11756.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5212.79},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6309.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11756.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9993.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6129.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9405.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6189.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9161.06},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9109.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7743.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6249.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7731.9,"maximum":17438.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7731.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8731.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17438.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14822.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13950.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8564.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13588.21},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8897.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8897.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13512.42},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11485.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8648.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":17430.22,"10th_percentile":17430.22,"90th_percentile":17430.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":14417.73,"10th_percentile":14417.73,"90th_percentile":14417.73},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7738.42,"10th_percentile":251.58,"90th_percentile":8032.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11825.65,"maximum":26671.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11825.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12665.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26671.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22670.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21337.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12424.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20782.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20666.72},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17566.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11264.41,"10th_percentile":11264.41,"90th_percentile":11264.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3296.29,"maximum":7434.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3296.29},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4467.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7434.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6319.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4340.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5947.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4382.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":5792.97},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4552.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4552.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5760.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4896.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4255.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4425.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4592.06,"maximum":10356.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4592.06},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10356.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8803.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5550.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8285.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5604.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8070.19},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5822.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5822.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8025.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6821.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11312.84,"maximum":25514.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11312.84},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12172.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25514.78},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21687.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20411.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11941.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19881.43},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19770.53},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16804.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11593.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12057.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11372.65,"10th_percentile":11372.65,"90th_percentile":11372.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4099.54,"maximum":9246.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4099.54},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5239.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9246.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7859.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7396.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7204.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5339.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5339.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7164.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6089.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4990.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5190.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4110.33,"10th_percentile":4110.33,"90th_percentile":4110.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6149.31,"maximum":13869.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6149.31},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7210.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13869.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11788.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7004.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11095.22},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7072.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10806.92},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10746.64},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9134.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6866.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":7912.35,"10th_percentile":7912.35,"90th_percentile":7912.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":10746.64,"10th_percentile":10746.64,"90th_percentile":10746.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6399.67,"10th_percentile":4714.23,"90th_percentile":9270.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9298.56,"maximum":20971.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9298.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20971.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17826.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9944.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16777.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10041.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16341.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10431.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10431.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16250.34},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13812.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9749.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10139.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":17348.57,"10th_percentile":17348.57,"90th_percentile":45625.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9169.01,"10th_percentile":5458.32,"90th_percentile":9297.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":14731.23,"10th_percentile":12184.58,"90th_percentile":24465.66},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":16250.34,"10th_percentile":9749.69,"90th_percentile":84421.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":18335.57,"10th_percentile":18335.57,"90th_percentile":18335.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"88","median_amount":9253.13,"10th_percentile":1005.0,"90th_percentile":9412.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":8998.54,"10th_percentile":7692.9,"90th_percentile":9847.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6733.82,"maximum":15187.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6733.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15187.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12909.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12149.86},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11834.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11768.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10002.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12363.08,"maximum":27883.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12363.08},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27883.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23700.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12805.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22306.76},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12931.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21727.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13433.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13433.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21605.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18364.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12554.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13056.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19180.09,"maximum":44207.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19601.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20139.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44207.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37576.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19563.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35366.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19755.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34447.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20522.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20522.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34255.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29116.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19180.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19947.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7750.73,"maximum":17480.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7750.73},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8749.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17480.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14858.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8499.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13984.69},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8582.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13621.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13545.33},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11513.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8332.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8665.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":17814.9,"10th_percentile":14615.01,"90th_percentile":36603.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7776.81,"10th_percentile":7776.81,"90th_percentile":7969.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":15093.81,"10th_percentile":15093.81,"90th_percentile":17229.82},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":11219.3,"10th_percentile":11219.3,"90th_percentile":11219.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":14716.07,"10th_percentile":14716.07,"90th_percentile":14716.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7735.01,"10th_percentile":249.08,"90th_percentile":8055.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15908.81,"maximum":36147.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16027.31},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16704.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36147.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30725.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16226.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28918.15},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16386.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28166.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17022.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17022.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28009.62},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23807.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15908.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":54076.22,"10th_percentile":54076.22,"90th_percentile":54076.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15055.15,"10th_percentile":15055.15,"90th_percentile":15055.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4337.83,"maximum":9783.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4337.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5468.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9783.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8315.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5312.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7826.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5364.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7623.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5573.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5573.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7580.88},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6443.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5208.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5416.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5013.6,"maximum":11307.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5013.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6118.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11307.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9611.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9046.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8811.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8761.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7447.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5827.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6060.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14346.93,"maximum":32357.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14346.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15089.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32357.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27504.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14658.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25886.24},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14801.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25213.6},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15376.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15376.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25072.97},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21311.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14945.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13237.04,"10th_percentile":13237.04,"90th_percentile":13237.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13430.83,"10th_percentile":13430.83,"90th_percentile":13430.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5237.41,"maximum":11812.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5237.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11812.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10040.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9449.89},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9204.34},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6454.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6454.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9153.0},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7779.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6031.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6273.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10012.61,"10th_percentile":10012.61,"90th_percentile":10012.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5756.35,"10th_percentile":5756.35,"90th_percentile":5756.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":9703.25,"10th_percentile":9703.25,"90th_percentile":9703.25},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5961.3,"10th_percentile":5961.3,"90th_percentile":5961.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":9153.0,"10th_percentile":9153.0,"90th_percentile":9153.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5557.54,"10th_percentile":5556.04,"90th_percentile":5834.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9703.25,"10th_percentile":9703.25,"90th_percentile":9703.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6657.04,"maximum":15014.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6657.04},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15014.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12762.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7478.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12011.33},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7551.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11699.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11633.97},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9888.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":6891.5,"10th_percentile":6891.5,"90th_percentile":6891.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":3802.87,"10th_percentile":3802.87,"90th_percentile":3802.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10273.77,"10th_percentile":2030.95,"90th_percentile":26474.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6987.86,"10th_percentile":6987.86,"90th_percentile":7016.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":12896.98,"10th_percentile":12896.98,"90th_percentile":12896.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":6803.35,"10th_percentile":525.0,"90th_percentile":7090.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6413.52,"10th_percentile":6115.69,"90th_percentile":7124.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11618.5,"maximum":26204.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11618.5},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26204.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22273.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12110.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20963.31},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20418.59},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20304.7},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17258.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":20158.9,"10th_percentile":20158.9,"90th_percentile":52032.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":12143.3,"10th_percentile":2266.48,"90th_percentile":40982.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5954.07,"10th_percentile":5954.07,"90th_percentile":11270.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":29421.39,"10th_percentile":29421.39,"90th_percentile":29421.39},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"65","median_amount":11396.2,"10th_percentile":1660.0,"90th_percentile":11439.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10804.31,"10th_percentile":10093.16,"90th_percentile":11940.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25148.48,"maximum":58913.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26121.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26405.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58913.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50076.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25651.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47130.53},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25902.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45905.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26908.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26908.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45649.81},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38801.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25148.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24159.81,"10th_percentile":24159.81,"90th_percentile":24159.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22464.88,"10th_percentile":22464.88,"90th_percentile":22464.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38142.11,"maximum":90927.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40315.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40049.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":90927.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77288.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38904.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72742.33},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":70852.16},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40812.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40812.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70456.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59886.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38142.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39667.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31858.79,"maximum":75446.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33451.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33451.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":75446.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64129.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32495.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60357.24},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32814.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58788.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34088.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34088.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58460.97},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49690.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31858.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33133.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":74429.2,"10th_percentile":74429.2,"90th_percentile":74429.2},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":72163.21,"10th_percentile":72163.21,"90th_percentile":72163.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30666.96,"10th_percentile":30666.96,"90th_percentile":30666.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41062.0,"maximum":98122.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43505.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43115.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":98122.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83403.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41883.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78497.73},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42293.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":76458.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43936.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43936.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76031.54},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64625.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41062.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42704.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39387.15,"10th_percentile":39387.15,"90th_percentile":39387.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36573.43,"maximum":87062.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38602.29},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38402.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":87062.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74003.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37304.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69650.3},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37670.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":67840.48},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39133.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39133.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67462.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57341.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38036.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22655.57,"maximum":52770.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23397.79},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23788.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52770.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44855.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23108.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42216.74},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23335.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41119.76},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24241.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24241.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40890.4},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34755.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22655.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23561.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56952.97,"maximum":137275.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60865.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59800.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":137275.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116684.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58092.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109820.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58661.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":106966.88},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60939.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106370.24},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90412.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56952.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59231.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54602.01,"10th_percentile":54602.01,"90th_percentile":54602.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40773.59,"maximum":97411.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43190.73},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42812.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":97411.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82799.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41589.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77929.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41996.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":75904.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43627.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75480.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64156.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42404.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28902.43,"maximum":68162.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30222.14},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30347.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68162.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57938.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29480.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54529.96},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29769.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53113.03},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30925.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30925.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52816.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44893.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28902.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30058.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37855.69,"maximum":90222.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40003.09},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39748.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":90222.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76688.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38612.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72177.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38991.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":70302.27},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40505.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40505.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69910.13},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59421.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39369.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18873.78,"maximum":43453.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19266.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19817.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43453.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36935.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19251.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34762.42},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33859.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20194.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20194.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33670.28},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28618.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18873.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19628.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":64528.34,"10th_percentile":64528.34,"90th_percentile":64528.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39025.9,"maximum":93105.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41281.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40977.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":93105.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79139.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39806.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74484.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40196.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":72548.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41757.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41757.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72144.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61320.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40586.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21888.47,"maximum":50880.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22559.77},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22982.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50880.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43248.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22326.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40704.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22545.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39647.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23420.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23420.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39425.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33511.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21888.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22764.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13209.06,"maximum":29791.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13209.06},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13995.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29791.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25322.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23833.17},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13728.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23213.88},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14262.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14262.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23084.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19621.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13329.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35749.98,"maximum":85034.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37702.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37537.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":85034.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72278.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36464.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68027.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36822.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":66259.54},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38252.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38252.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65889.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56004.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35749.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37179.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33492.48,"10th_percentile":33492.48,"90th_percentile":33492.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24619.4,"maximum":57609.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25543.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25850.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57609.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48968.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25111.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46087.65},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25357.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44890.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26342.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26342.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44639.7},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37942.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24619.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25604.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19457.22,"maximum":44890.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19903.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20430.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44890.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38157.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19846.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35912.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20040.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34979.29},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20819.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20819.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34784.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29565.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19457.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20235.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17670.43,"10th_percentile":17670.43,"90th_percentile":17670.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21348.12,"maximum":49549.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21969.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22415.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49549.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42117.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21775.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39639.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38609.6},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22842.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22842.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38394.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32634.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21348.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22202.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3861.2,"10th_percentile":3861.2,"90th_percentile":3861.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19586.63,"10th_percentile":19586.63,"90th_percentile":19586.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13971.02,"maximum":31509.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13971.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14727.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31509.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26783.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14307.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25207.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24552.97},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15008.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15008.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24416.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20753.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14026.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14587.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12847.62,"10th_percentile":12847.62,"90th_percentile":12847.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12966.84,"10th_percentile":12956.32,"90th_percentile":13470.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33252.43,"maximum":78880.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34974.27},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34915.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":78880.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67048.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33917.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63104.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34250.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61464.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35580.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35580.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61121.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51951.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33252.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34582.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20770.64,"maximum":48126.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21338.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21809.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":48126.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40907.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21186.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38501.34},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21393.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37500.91},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22224.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22224.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37291.73},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31697.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20770.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21601.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1168.13,"10th_percentile":1168.13,"90th_percentile":1168.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19961.05,"10th_percentile":19961.05,"90th_percentile":19961.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17423.78,"maximum":39880.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17682.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18294.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39880.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33898.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17772.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31904.32},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17946.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31075.31},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18643.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18643.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30901.98},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26265.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17423.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29700.03,"maximum":70127.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31093.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31185.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":70127.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59608.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30294.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56102.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30591.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54644.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31779.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31779.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54339.53},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46187.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29700.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30888.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20535.97,"10th_percentile":20535.97,"90th_percentile":28467.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16325.84,"maximum":37175.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16482.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17142.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37175.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31598.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16652.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29740.17},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16815.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28967.39},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17468.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17468.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28805.81},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24484.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16325.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16978.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8548.19,"maximum":19279.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8548.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19279.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16387.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9243.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15423.54},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9334.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15022.77},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14938.97},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12697.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9062.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9425.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24142.04,"maximum":56433.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25021.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25349.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56433.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47968.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24624.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45146.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43973.6},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25831.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25831.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43728.33},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37168.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24142.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25107.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17542.46,"maximum":40172.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17811.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18419.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40172.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34146.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17893.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32138.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18068.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31303.16},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31128.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26458.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17542.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16886.13,"10th_percentile":16886.13,"90th_percentile":16886.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13464.01,"maximum":30366.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13464.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14240.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30366.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25811.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24293.18},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23661.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23529.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19999.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14104.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20546.55,"maximum":47574.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21093.79},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21573.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47574.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40438.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20957.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38059.63},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21162.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37070.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21984.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21984.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36863.89},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31333.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20546.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21368.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18078.64,"10th_percentile":1526.41,"90th_percentile":19695.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15124.47,"maximum":34215.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15170.46},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15880.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34215.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29082.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15426.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27372.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15578.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26660.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16183.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16183.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26512.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22534.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15124.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15729.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":31893.88,"10th_percentile":31893.88,"90th_percentile":31893.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14418.87,"10th_percentile":14418.87,"90th_percentile":14418.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14189.27,"10th_percentile":14166.4,"90th_percentile":14544.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12899.15,"10th_percentile":12074.02,"90th_percentile":13023.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11813.33,"maximum":26643.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11813.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12654.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26643.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22647.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12292.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21314.85},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12412.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20761.0},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20645.2},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17547.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12051.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12533.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":25139.86,"10th_percentile":25139.86,"90th_percentile":25139.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11046.66,"10th_percentile":11046.66,"90th_percentile":11046.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19615.68,"maximum":45281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20076.87},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20596.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45281.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38488.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20007.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36224.8},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35283.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20988.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20988.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35086.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29822.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20400.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17190.36,"10th_percentile":17190.36,"90th_percentile":17190.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22633.7,"maximum":52717.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23373.89},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23765.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52717.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44809.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23086.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42173.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23312.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41077.76},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24218.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24218.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40848.63},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34720.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22633.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23539.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15101.93,"maximum":34159.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15145.84},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15857.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34159.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29035.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15403.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27327.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26617.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16159.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16159.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26469.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22498.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15101.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15706.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11343.99,"maximum":25585.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11343.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12202.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25585.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21747.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20468.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19936.16},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12435.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12435.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19824.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16850.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11621.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12086.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12812.14,"maximum":28896.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12812.14},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28896.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24561.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13225.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23117.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13354.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22516.33},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22390.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19031.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12965.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13484.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12496.86,"10th_percentile":12496.86,"90th_percentile":12496.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8088.98,"maximum":18243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8088.98},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9074.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18243.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15507.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8815.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14594.99},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14215.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14136.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12015.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8987.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25580.76,"maximum":59978.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26593.4},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26859.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59978.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50981.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26092.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47982.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26348.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46735.8},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27371.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27371.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46475.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39502.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25580.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26603.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":61251.98,"10th_percentile":61251.98,"90th_percentile":61251.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2859.32,"10th_percentile":2859.32,"90th_percentile":2859.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24564.17,"10th_percentile":24564.17,"90th_percentile":24564.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18052.31,"maximum":41429.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18368.97},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18954.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41429.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35214.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18413.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33143.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18593.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32282.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19315.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19315.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32101.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27285.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18052.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18774.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14533.08,"maximum":32777.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14533.08},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15268.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32777.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27860.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14831.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26222.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25540.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15558.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15558.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25398.28},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21587.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14541.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15122.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12949.99,"10th_percentile":12949.99,"90th_percentile":12949.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25276.44,"maximum":59228.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26260.95},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26540.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59228.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50344.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25781.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47382.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26034.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46151.54},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27045.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27045.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45894.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39008.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25276.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26287.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13065.65,"maximum":29468.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13065.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13857.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29468.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25047.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13461.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23574.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13593.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22961.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14121.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14121.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22833.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19408.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13197.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13725.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8751.72,"maximum":19738.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8751.72},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9711.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19738.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16777.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15790.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9526.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15380.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15294.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13000.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9248.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9618.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21239.39,"maximum":49281.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21850.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22301.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49281.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41889.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21664.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39425.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21876.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38400.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22726.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22726.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38186.65},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32457.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21239.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22088.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20369.72,"10th_percentile":20369.72,"90th_percentile":20369.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14593.2,"maximum":32913.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14593.2},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15325.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32913.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27976.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26330.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15033.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25646.39},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15617.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15617.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25503.34},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21677.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14596.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15179.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22220.64,"maximum":51699.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22922.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23331.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51699.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43944.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22665.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41359.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22887.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40284.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40060.04},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34050.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22220.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23109.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12661.49,"maximum":28556.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12661.49},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13469.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28556.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24273.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22845.18},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13212.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22251.56},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13725.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13725.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22127.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18807.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12827.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13340.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":15533.31,"10th_percentile":15533.31,"90th_percentile":15533.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9748.35,"maximum":21986.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9748.35},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21986.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18688.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10364.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17589.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10466.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17131.96},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10872.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10872.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17036.4},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14480.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10567.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19742.98,"maximum":45594.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20215.94},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20730.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45594.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38755.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36475.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20335.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35527.91},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21124.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21124.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35329.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30029.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19742.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20532.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1980.01,"10th_percentile":1980.01,"90th_percentile":1980.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13538.62,"maximum":30534.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13538.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14312.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30534.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25954.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13903.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24427.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14039.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23793.05},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14584.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14584.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23660.33},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20110.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13630.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14175.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12142.86,"10th_percentile":12142.86,"90th_percentile":12142.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12985.25,"maximum":29286.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12985.25},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13780.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29286.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24893.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13386.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23429.35},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13517.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22820.55},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22693.26},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19288.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9772.26,"maximum":22040.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9772.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22040.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18734.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17632.13},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10488.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17173.97},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10895.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10895.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17078.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14516.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10590.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13083.76,"maximum":29508.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13083.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13875.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29508.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25082.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13478.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23607.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13610.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22993.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22865.41},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19435.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13742.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10968.8,"maximum":24738.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10968.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11842.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24738.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21028.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11503.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19791.06},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11616.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19276.8},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12067.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12067.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19169.28},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16293.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11278.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11729.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21263.92,"maximum":49342.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21877.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22327.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49342.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41940.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21689.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39473.65},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21901.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38447.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22752.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22752.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38233.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32497.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21263.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22114.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15024.35,"maximum":33968.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15061.09},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15775.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33968.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28873.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15324.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27174.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15475.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26468.68},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16076.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16076.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26321.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22372.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15024.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15625.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11990.06,"maximum":27042.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11990.06},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12823.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27042.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22985.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12457.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21633.73},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12579.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21071.59},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20954.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17810.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12701.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11402.65,"maximum":25717.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11402.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12259.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25717.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21859.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20573.87},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12025.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20039.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12492.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12492.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19927.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16937.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11675.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12142.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7404.52,"maximum":16700.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7404.52},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8416.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16700.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14195.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13360.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13012.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8576.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8576.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12940.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10998.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8015.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8336.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7428.09,"10th_percentile":7428.09,"90th_percentile":7428.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22367.17,"maximum":52060.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23082.72},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23485.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52060.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44251.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22814.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41648.26},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23038.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40566.05},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23932.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23932.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40339.78},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34287.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22367.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23261.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15015.74,"maximum":33947.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15051.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15766.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33947.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28855.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27157.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15466.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26452.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16066.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16066.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26304.59},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22358.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15015.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15616.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11130.32,"maximum":25103.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11130.32},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11997.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25103.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21337.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11654.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20082.49},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19560.65},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12226.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12226.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19451.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16533.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11426.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11883.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26016.36,"maximum":61051.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27069.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27317.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61051.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51893.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26536.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48841.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26796.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47572.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27837.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27837.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47306.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40209.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26016.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27057.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14487.45,"maximum":32674.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14487.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15224.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32674.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27773.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26139.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14934.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25460.55},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15514.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15514.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25318.53},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21520.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14499.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15079.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10820.32,"maximum":24403.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10820.32},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11699.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24403.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20743.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11365.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19523.15},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11476.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19015.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18909.79},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16072.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11142.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11588.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20267.42,"maximum":46886.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20788.86},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21280.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46886.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39853.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37509.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20875.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36534.78},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36330.99},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30880.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20267.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21078.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19379.22,"10th_percentile":19379.22,"90th_percentile":19379.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19267.43,"10th_percentile":17956.15,"90th_percentile":19533.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15278.29,"maximum":34594.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15338.5},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16042.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34594.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29405.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15583.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27675.33},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15736.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26956.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16347.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16347.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26805.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22784.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15278.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15889.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14284.22,"10th_percentile":14284.22,"90th_percentile":14284.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":31123.23,"10th_percentile":31123.23,"90th_percentile":31123.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14701.03,"10th_percentile":14402.68,"90th_percentile":14706.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11354.85,"maximum":25609.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11354.85},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25609.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21768.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11864.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20487.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11980.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19955.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12445.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12445.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19843.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16866.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5838.58,"maximum":13168.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5838.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6911.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13168.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11193.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6713.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10534.58},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6779.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10260.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7043.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7043.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10203.61},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8672.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6582.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6845.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9285.53,"maximum":20942.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9285.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10224.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20942.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17801.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9932.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16753.92},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10029.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16318.58},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10419.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10419.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16227.56},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13793.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9737.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10127.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5849.45,"maximum":13192.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5849.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6921.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13192.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11213.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6724.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10554.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6789.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10279.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10222.6},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8688.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6855.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1792.79,"10th_percentile":1792.79,"90th_percentile":1792.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6105.33,"10th_percentile":6105.33,"90th_percentile":6105.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6911.99,"maximum":15589.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6911.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7943.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15589.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13250.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12471.35},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12147.28},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12079.53},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10267.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5217.13,"maximum":11766.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5217.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6314.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11766.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10001.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6133.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9413.3},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9168.7},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6434.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6434.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9117.56},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7749.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6253.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14266.54,"maximum":32176.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14266.54},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32176.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27350.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25741.18},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14725.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25072.31},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24932.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21192.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14297.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14868.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9389.1,"maximum":21176.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9389.1},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21176.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17999.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16940.8},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16500.6},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10520.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10520.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16408.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13946.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10225.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5703.14,"maximum":12862.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5703.14},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12862.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10933.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6587.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10290.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10022.81},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6910.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6910.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9966.91},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8471.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12794.76,"maximum":28857.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12794.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28857.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24528.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23085.65},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13338.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22485.78},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13856.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13856.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22360.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19005.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13467.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7445.8,"maximum":16793.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7445.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8456.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16793.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14274.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13434.5},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8295.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13085.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13012.42},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11060.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5465.57,"maximum":12326.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5465.57},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6552.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12326.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10477.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6365.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9861.55},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6428.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9605.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6677.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6677.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9551.73},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8118.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6240.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6490.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5758.47,"10th_percentile":5758.47,"90th_percentile":5758.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17691.63,"maximum":40540.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17974.95},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18576.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40540.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34459.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18045.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32432.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18222.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31589.56},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18930.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18930.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31413.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26700.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17691.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18399.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12844.81,"10th_percentile":12844.81,"90th_percentile":12844.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8354.08,"maximum":18841.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8354.08},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9329.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18841.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16015.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9062.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15073.3},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14681.63},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9506.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9506.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14599.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12409.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9240.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8276.32,"10th_percentile":8276.32,"90th_percentile":8276.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7757.25,"maximum":17495.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7757.25},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8755.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17495.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14871.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8505.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13996.45},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13632.76},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8922.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8922.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13556.72},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11522.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8672.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12791.14,"maximum":28848.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12791.14},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13593.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28848.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24521.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13205.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23079.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13334.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22479.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22354.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19000.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12946.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13464.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5468.47,"maximum":12333.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5468.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12333.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10483.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9866.78},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9610.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9556.79},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8123.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6493.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7069.17,"maximum":15943.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7069.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15943.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13552.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7862.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12754.93},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7939.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12423.5},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8248.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8248.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12354.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10500.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7708.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8017.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1645.0,"10th_percentile":1645.0,"90th_percentile":7259.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11318.64,"maximum":25527.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11318.64},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12178.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25527.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21698.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20422.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11946.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19891.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19780.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16813.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":22894.4,"10th_percentile":22894.4,"90th_percentile":22894.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11044.7,"10th_percentile":11044.7,"90th_percentile":11044.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11245.84,"10th_percentile":11086.71,"90th_percentile":11279.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10128.33,"10th_percentile":10128.33,"90th_percentile":10128.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5830.62,"maximum":13150.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5830.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6903.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13150.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11177.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6706.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10520.21},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10246.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7035.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7035.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10189.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8661.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6574.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6837.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":16652.5,"10th_percentile":16652.5,"90th_percentile":16652.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6106.07,"10th_percentile":6106.07,"90th_percentile":6118.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6654.9,"10th_percentile":6654.9,"90th_percentile":6654.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9948.98,"maximum":22438.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9948.98},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22438.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19072.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10551.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17951.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10655.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17484.55},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11068.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11068.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17387.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14778.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10758.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":18957.9,"10th_percentile":18957.9,"90th_percentile":22365.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":500.0,"10th_percentile":500.0,"90th_percentile":500.0},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9955.39,"10th_percentile":1675.0,"90th_percentile":9983.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8571.22,"10th_percentile":8571.22,"90th_percentile":10446.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20971.53,"maximum":48621.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21558.07},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22020.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":48621.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41328.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21390.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38897.32},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21600.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37886.6},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22439.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22439.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37675.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32023.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20971.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21810.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9896.84,"maximum":22321.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9896.84},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22321.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18972.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17856.91},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10606.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17392.91},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11017.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17295.89},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14701.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10297.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10708.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13062.03,"maximum":29459.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13062.03},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13854.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29459.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25040.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23567.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13590.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22955.48},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14118.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14118.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22827.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19402.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13194.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13722.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26019.01,"maximum":61058.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27072.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27319.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61058.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51899.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26539.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48846.43},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26799.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47577.18},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27840.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27840.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47311.81},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40213.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26019.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27059.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25560.82,"10th_percentile":25560.82,"90th_percentile":25560.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20963.5,"10th_percentile":20963.5,"90th_percentile":20963.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13864.55,"maximum":31269.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13864.55},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14625.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31269.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26579.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25015.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14346.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24365.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24229.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20594.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14486.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17972.09,"maximum":41231.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18281.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18870.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41231.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35046.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18331.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32985.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18511.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32128.0},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19230.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19230.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31948.79},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27155.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18690.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":6674.24,"10th_percentile":6674.24,"90th_percentile":6674.24},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16981.49,"10th_percentile":2588.64,"90th_percentile":17000.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30952.45,"maximum":73213.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32461.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32500.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":73213.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62231.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31571.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58570.76},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31881.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57048.83},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33119.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33119.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56730.62},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48219.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30952.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32190.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":89221.43,"10th_percentile":89221.43,"90th_percentile":101469.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29401.56,"10th_percentile":29401.56,"90th_percentile":29401.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30378.23,"10th_percentile":30378.23,"90th_percentile":30399.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5131.67,"maximum":11573.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5131.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11573.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9837.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9259.09},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6113.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9018.5},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6350.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6350.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8968.19},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7622.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5935.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6172.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6589.68,"maximum":14862.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6589.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7633.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14862.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12632.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7415.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11889.79},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11580.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7778.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7778.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11516.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9788.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7269.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12434.78,"maximum":28045.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12434.78},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28045.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23838.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12872.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22436.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12998.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21853.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13503.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13503.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21731.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18471.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12620.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13125.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5005.64,"maximum":11289.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5005.64},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6110.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11289.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9596.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9031.7},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8797.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8747.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7435.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6052.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6638.21,"maximum":14971.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6638.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14971.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12725.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7460.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11977.35},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11666.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7826.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7826.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11601.06},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9860.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11324.43,"maximum":25540.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11324.43},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12184.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25540.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21709.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11835.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20432.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11952.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19901.79},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12416.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12416.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19790.78},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16821.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11603.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9949.69,"10th_percentile":9949.69,"90th_percentile":9949.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5346.78,"maximum":12059.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5346.78},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6438.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12059.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10250.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9647.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9396.55},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9344.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7942.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6132.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6377.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":2352.96,"10th_percentile":2352.96,"90th_percentile":2352.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":9928.91,"10th_percentile":9928.91,"90th_percentile":9928.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8562.67,"maximum":19312.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8562.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9529.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19312.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16415.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15449.68},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15048.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9711.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9711.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14964.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12719.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9075.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9438.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5316.36,"maximum":11990.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5316.36},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11990.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10191.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6226.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9592.34},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6287.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9343.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9290.97},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7897.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6104.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6348.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9644.05,"maximum":21751.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9644.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10569.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21751.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18488.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10267.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17400.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10367.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16948.66},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16854.13},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14325.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10065.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5443.84,"maximum":12277.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5443.84},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12277.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10436.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6345.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9822.34},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9567.12},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6656.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6656.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9513.75},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8086.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6469.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":11942.33,"10th_percentile":11942.33,"90th_percentile":11942.33},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":670.0,"10th_percentile":670.0,"90th_percentile":670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5773.4,"maximum":13021.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5773.4},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6848.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13021.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11068.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10416.97},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6718.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10146.29},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6979.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10089.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8576.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6522.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14071.7,"maximum":31737.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14071.7},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14824.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31737.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26976.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14401.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25389.64},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14542.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24729.9},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24591.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20902.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14118.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14683.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17086.97,"maximum":39050.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17314.39},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17941.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39050.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33192.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31240.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17599.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30428.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18283.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18283.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30258.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25719.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17086.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26900.81,"maximum":63230.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28035.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28245.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":63230.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53746.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50584.55},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27707.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49270.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28783.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28783.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48995.32},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41644.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26900.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27976.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12044.38,"maximum":27164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12044.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12876.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27164.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23089.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12508.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21731.74},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12630.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21167.05},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21048.99},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17891.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12262.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15366.47,"maximum":34811.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15434.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16134.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34811.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29589.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15673.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27849.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15827.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27125.5},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26974.2},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22927.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15981.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30943.84,"maximum":73192.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32452.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32491.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":73192.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62213.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31562.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58553.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31872.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57032.28},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33109.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33109.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56714.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48205.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30943.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32181.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15792.12,"maximum":35860.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15899.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16581.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35860.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30481.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16107.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28688.15},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16265.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27942.7},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16897.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16897.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27786.84},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23618.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15792.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16423.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23856.94,"maximum":55730.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24710.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25049.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":55730.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47371.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24334.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44584.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24572.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43426.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25526.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25526.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43184.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36705.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23856.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24811.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41073.27,"maximum":98149.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43518.12},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43126.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":98149.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83427.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41894.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78519.95},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42305.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":76479.65},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43948.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43948.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76053.06},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64643.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41073.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42716.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17964.79,"maximum":41213.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18273.36},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18863.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41213.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35031.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32970.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18503.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32113.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19222.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19222.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31934.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27143.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17964.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18683.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21852.01,"maximum":50791.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22519.94},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22944.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50791.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43172.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22289.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40632.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22507.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39577.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39356.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33451.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21852.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22726.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31382.75,"maximum":74273.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32931.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32951.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":74273.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63132.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32010.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59418.91},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32324.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57874.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33579.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33579.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57552.13},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48917.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31382.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32638.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27173.97,"maximum":63903.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28333.89},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":63903.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54318.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27717.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51122.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27989.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49794.58},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29076.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29076.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49516.83},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42088.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27173.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28260.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39230.11,"maximum":93608.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41504.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":93608.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79567.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40014.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74886.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40407.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":72940.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41976.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41976.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72534.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61652.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39230.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40799.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22304.18,"maximum":51905.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23013.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23419.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51905.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44119.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22750.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41524.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40445.12},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40219.53},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34185.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22304.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23196.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36336.08,"maximum":86478.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38342.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38152.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":86478.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73506.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37062.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69182.45},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37426.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":67384.78},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38879.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38879.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67008.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56955.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36336.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37789.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53408.53,"maximum":128542.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56993.72},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56078.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":128542.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109261.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54476.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102834.04},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55010.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":100161.96},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99603.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84660.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53408.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55544.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48540.73,"maximum":116548.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51675.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50967.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":116548.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99066.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49511.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93239.09},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49996.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":90816.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51938.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51938.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90309.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76761.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48540.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50482.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":287543.11,"maximum":705422.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":312773.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301920.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":705422.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":599609.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":293293.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":564337.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296169.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":549673.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307671.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307671.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":546607.88},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":464603.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":287543.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299044.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37254.34,"maximum":88740.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39346.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39117.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":88740.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75429.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37999.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70992.45},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38371.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":69147.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39862.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39862.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68762.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58446.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37254.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38744.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40552.14,"maximum":96865.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42948.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42579.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":96865.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82336.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41363.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77492.76},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41768.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":75479.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43390.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43390.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75058.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63797.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40552.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42174.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":80917.39,"maximum":196321.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87045.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84963.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":196321.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":166872.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82535.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":157056.89},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83344.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":152975.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86581.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86581.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152122.58},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129300.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80917.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84154.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20344.33,"maximum":47076.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20872.88},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21361.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47076.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40014.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20751.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37661.03},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20954.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36682.43},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21768.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21768.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36477.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31005.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20344.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29190.18,"maximum":68871.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30536.49},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30649.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68871.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58540.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29773.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55097.13},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30065.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53665.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31233.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31233.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53366.13},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45359.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30357.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37398.88,"maximum":89096.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39504.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39268.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":89096.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75732.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38146.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71277.34},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38520.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":69425.24},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40016.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40016.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69038.0},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58680.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38894.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35892.09,"10th_percentile":35892.09,"90th_percentile":35892.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48813.22,"maximum":117220.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51973.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51253.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":117220.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99637.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49789.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93776.21},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50277.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":91339.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52230.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90830.01},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77203.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48813.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50765.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18084.14,"maximum":41507.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18403.74},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18988.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41507.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35281.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33205.95},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18626.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32343.12},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32162.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27337.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18807.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9433.81,"10th_percentile":9433.81,"90th_percentile":9433.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9573.07,"maximum":21590.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9573.07},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10500.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21590.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18352.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10200.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17272.74},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10300.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16823.92},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10700.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10700.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16730.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14220.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10000.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10400.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":17408.55,"10th_percentile":17408.55,"90th_percentile":17408.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9651.75,"10th_percentile":9651.75,"90th_percentile":9651.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7499.4,"maximum":16914.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7499.4},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16914.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14376.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8264.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13531.21},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8345.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13179.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8669.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8669.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13106.09},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11139.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8426.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":16933.57,"10th_percentile":16933.57,"90th_percentile":27206.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6228.81,"10th_percentile":6228.81,"90th_percentile":6228.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":12493.65,"10th_percentile":12493.65,"90th_percentile":12493.65},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":13663.36,"10th_percentile":13663.36,"90th_percentile":13663.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7481.41,"10th_percentile":7348.81,"90th_percentile":7831.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21535.75,"maximum":50011.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22174.44},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22612.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50011.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42510.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21966.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40009.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22181.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38969.83},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23043.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23043.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38752.47},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32938.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21535.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22397.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11010.81,"maximum":24833.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11010.81},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24833.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21108.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11543.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19866.86},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19350.63},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19242.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16355.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7582.7,"maximum":17101.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7582.7},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17101.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14536.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13681.5},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13325.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13251.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11263.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8178.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8505.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21931.57,"maximum":50987.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22606.85},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23028.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50987.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43339.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22370.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40789.65},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22589.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":39729.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23466.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23466.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39508.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33580.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21931.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22808.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12670.18,"maximum":28576.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12670.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13477.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28576.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24289.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13092.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22860.87},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22266.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22142.64},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18820.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13349.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8012.21,"maximum":18070.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8012.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9000.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18070.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15360.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8743.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14456.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8829.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14080.82},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14002.28},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11901.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8571.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8914.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20597.6,"maximum":47700.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21149.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21627.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47700.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40545.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21009.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38160.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21215.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37168.68},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36961.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31416.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20597.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21421.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11241.14,"maximum":25353.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11241.14},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12104.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25353.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21550.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20282.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19755.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12334.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19645.22},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16697.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11527.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11099.6,"10th_percentile":11099.6,"90th_percentile":11099.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7078.58,"maximum":15964.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7078.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8103.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15964.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13570.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7871.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12771.92},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12440.05},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8257.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8257.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12370.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10514.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7717.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8026.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13001.19,"maximum":29322.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13001.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13795.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29322.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24924.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13401.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23458.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13532.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22848.56},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14058.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14058.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22721.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19312.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13138.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13664.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7818.82,"maximum":17634.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7818.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8814.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17634.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14989.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14107.53},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13740.96},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13664.31},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11614.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29094.71,"maximum":68636.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30432.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30549.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68636.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58340.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54908.95},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29967.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53482.17},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31131.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31131.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53183.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45205.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29094.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30258.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":75641.35,"10th_percentile":75641.35,"90th_percentile":75641.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1572.33,"10th_percentile":1572.33,"90th_percentile":1572.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":49449.7,"10th_percentile":49449.7,"90th_percentile":49449.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22492.79,"10th_percentile":16065.87,"90th_percentile":27928.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16742.87,"maximum":38202.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16938.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17580.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38202.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32472.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17077.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30562.18},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17245.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29768.04},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17914.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29602.0},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25161.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16742.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17412.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15906.8,"10th_percentile":15906.8,"90th_percentile":15906.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":20571.77,"10th_percentile":20571.77,"90th_percentile":20571.77},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":27527.67,"10th_percentile":27527.67,"90th_percentile":27527.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15698.6,"10th_percentile":15698.6,"90th_percentile":15698.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11888.66,"maximum":26813.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11888.66},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12726.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26813.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22791.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21450.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20893.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12968.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12968.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20776.84},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17659.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12120.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11641.43,"10th_percentile":11641.43,"90th_percentile":11641.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10726.88,"maximum":24193.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10726.88},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11609.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24193.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20564.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11278.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19354.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11388.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18851.65},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11830.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11830.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18746.5},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15934.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11499.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":14260.25,"10th_percentile":14260.25,"90th_percentile":20279.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":2345.0,"10th_percentile":251.58,"90th_percentile":10662.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9015.14,"10th_percentile":8115.64,"90th_percentile":11162.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6343.42,"maximum":14306.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6343.42},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7396.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14306.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12160.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11445.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11148.06},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11085.88},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9422.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7326.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":7129.81,"10th_percentile":7129.81,"90th_percentile":7129.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":26007.57,"10th_percentile":26007.57,"90th_percentile":26007.57},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10438.11,"10th_percentile":10438.11,"90th_percentile":10438.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":12506.4,"10th_percentile":12506.4,"90th_percentile":12506.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":6599.19,"10th_percentile":251.28,"90th_percentile":6826.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5013.45,"10th_percentile":5013.45,"90th_percentile":5013.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4347.97,"maximum":9806.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4347.97},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5478.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9806.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8335.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5322.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7845.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5374.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7641.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7598.6},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6458.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5217.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5426.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":5936.99,"10th_percentile":5936.99,"90th_percentile":5936.99},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5077.16,"10th_percentile":5077.16,"90th_percentile":5077.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13064.2,"maximum":29464.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13064.2},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13856.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29464.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25045.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23571.8},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13592.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22959.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14120.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14120.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22831.23},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19406.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13196.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12985.02,"10th_percentile":12985.02,"90th_percentile":12985.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7589.22,"maximum":17116.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7589.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8594.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17116.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14549.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13693.26},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8430.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13337.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13263.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11273.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8512.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5724.14,"maximum":12910.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5724.14},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6801.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12910.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10973.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10328.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10059.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10003.62},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8502.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8404.05,"maximum":18954.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8404.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9377.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18954.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16111.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9109.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15163.47},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9198.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14769.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14687.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12483.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8930.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":18871.78,"10th_percentile":18871.78,"90th_percentile":18871.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8298.16,"10th_percentile":8298.16,"90th_percentile":8298.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":15925.81,"10th_percentile":15925.81,"90th_percentile":15925.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1675.0,"10th_percentile":250.08,"90th_percentile":8588.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5863.21,"maximum":13223.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5863.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6935.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13223.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11240.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10579.02},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6802.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10304.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10246.65},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8709.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6604.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6869.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10903.16,"10th_percentile":10903.16,"90th_percentile":10903.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1763.12,"10th_percentile":1763.12,"90th_percentile":1763.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":8466.96,"10th_percentile":8466.96,"90th_percentile":8466.96},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":7756.38,"10th_percentile":7756.38,"90th_percentile":7756.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6049.29,"10th_percentile":251.28,"90th_percentile":7514.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9738.21,"maximum":21963.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9738.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10659.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21963.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18668.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17570.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17114.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10862.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17018.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14465.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.85,"maximum":12769.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.85},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12769.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10854.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10215.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6613.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9950.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6869.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6869.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9894.76},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8410.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6677.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8284.54,"maximum":18684.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8284.54},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9262.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18684.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15882.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8997.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14947.84},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9085.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14559.43},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9438.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.22},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12306.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4990.43,"maximum":11255.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4990.43},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6096.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11255.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9567.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5922.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9004.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5980.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8770.28},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8721.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7412.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5805.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7806.51,"maximum":17606.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7806.51},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17606.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14965.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14085.32},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13719.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13642.79},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11596.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8383.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8719.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.58,"10th_percentile":251.58,"90th_percentile":251.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11982.82,"maximum":27025.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11982.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12816.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27025.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22971.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21620.66},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12572.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21058.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20941.4},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17799.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12206.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12694.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11520.78,"10th_percentile":11520.78,"90th_percentile":11520.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":9879.85,"10th_percentile":251.28,"90th_percentile":11723.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10926.14,"10th_percentile":10926.14,"90th_percentile":10926.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7351.65,"maximum":16580.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7351.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8365.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16580.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14093.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13264.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12919.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12847.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10920.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8285.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":16675.51,"10th_percentile":16675.51,"90th_percentile":19127.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7414.13,"10th_percentile":251.28,"90th_percentile":7441.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4996.95,"maximum":11270.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4996.95},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6102.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11270.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9579.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5928.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9016.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5986.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8781.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6218.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6218.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8732.75},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7422.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5811.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6044.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":4460.91,"10th_percentile":4460.91,"90th_percentile":4460.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14488.17,"maximum":32676.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14488.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15224.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32676.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27774.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26141.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14934.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25461.82},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15514.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15514.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25319.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21521.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14499.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15079.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11112.21,"maximum":25062.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11112.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11980.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25062.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21302.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11637.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20049.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11751.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19528.83},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12208.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19419.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16506.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11409.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11866.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16666.62,"maximum":38014.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16855.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17499.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38014.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32312.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16999.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30411.89},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17166.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29621.66},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17833.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29456.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25037.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16666.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17333.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10148.89,"maximum":22889.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10148.89},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22889.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19456.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10738.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18311.69},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10843.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17835.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17736.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15075.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10527.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15053.53,"maximum":34040.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15092.96},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15806.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34040.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28934.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15354.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27232.31},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15505.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26524.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16107.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16107.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26376.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22419.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15655.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7965.13,"maximum":17964.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7965.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8955.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17964.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15269.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8699.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14371.52},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13998.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13920.0},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11831.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8870.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10889.13,"maximum":24559.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10889.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24559.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20875.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11429.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19647.3},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11541.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19136.78},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11989.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11989.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19030.04},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16175.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11205.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11653.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10702.61,"10th_percentile":10702.61,"90th_percentile":10702.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10117.03,"10th_percentile":10117.03,"90th_percentile":10117.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7658.75,"maximum":17273.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7658.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8660.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17273.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14682.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13818.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8495.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13459.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13384.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11376.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8248.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8578.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16071.24,"maximum":36547.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16204.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16874.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36547.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31065.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16392.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29238.33},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16553.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28478.59},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17196.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17196.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28319.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24071.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16071.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16714.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10654.45,"maximum":24029.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10654.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24029.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20425.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19223.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18724.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18619.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15826.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10990.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11430.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13692.89,"maximum":30882.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13692.89},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14460.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30882.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26250.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14047.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24706.15},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14185.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24064.17},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23929.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20339.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9728.07,"maximum":21940.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9728.07},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21940.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18649.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17552.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17096.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10852.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10852.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17000.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14450.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10548.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":2500.96,"10th_percentile":2500.96,"90th_percentile":2500.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13107.66,"maximum":29562.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13107.66},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13898.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29562.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25128.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13500.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23650.21},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13633.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23035.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14162.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14162.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22907.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19470.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13236.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13765.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8276.58,"maximum":18666.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8276.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9254.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18666.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15866.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8990.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14933.47},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14545.43},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14464.3},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12294.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8813.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9166.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8476.71,"10th_percentile":8476.71,"90th_percentile":8476.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4749.24,"maximum":10711.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4749.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10711.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9104.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8569.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5752.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8346.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5976.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5976.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8299.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7054.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5585.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5808.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8475.76,"maximum":19116.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8475.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9446.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19116.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16248.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15292.85},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9266.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14895.48},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9626.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9626.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14812.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12590.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9356.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5229.45,"maximum":11794.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5229.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6325.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11794.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10025.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6145.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9435.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9190.34},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9139.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7768.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5846.95,"10th_percentile":5846.95,"90th_percentile":5846.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3886.45,"10th_percentile":3886.45,"90th_percentile":3886.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10740.64,"maximum":24224.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10740.64},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11622.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24224.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20590.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11290.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19379.4},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11401.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18875.83},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11844.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11844.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18770.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15954.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11069.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11512.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2010.0,"10th_percentile":2010.0,"90th_percentile":2010.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8450.97,"10th_percentile":8450.97,"90th_percentile":8450.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5875.52,"maximum":13251.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5875.52},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6946.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13251.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11263.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10601.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10325.76},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10268.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8727.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6880.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7668.16,"maximum":17294.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7668.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8669.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17294.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14700.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13835.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13476.19},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8835.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8835.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13401.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11390.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8257.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4867.3,"maximum":10977.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4867.3},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5977.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10977.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9330.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5807.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8782.09},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5863.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8553.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6091.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6091.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8506.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7230.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5920.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15359.84,"maximum":34795.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15427.59},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16127.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34795.1},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29575.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15667.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27836.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15820.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27112.77},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16435.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16435.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26961.54},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22916.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15974.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9745.46,"maximum":21979.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9745.46},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10666.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21979.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18682.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10361.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17583.77},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10463.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17126.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10869.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10869.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17031.34},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14476.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10158.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10564.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24936.98,"maximum":58392.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25890.1},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26183.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58392.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49633.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25435.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46713.64},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25685.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45499.81},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26682.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26682.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45246.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38458.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24936.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25934.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14899.71,"maximum":33661.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14924.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33661.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28612.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26929.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15346.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26229.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15942.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15942.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26083.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22170.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15495.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10636.35,"maximum":23989.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10636.35},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23989.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20390.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11193.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19191.21},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11303.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18692.54},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18588.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15799.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10974.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24992.01,"maximum":58527.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25950.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58527.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49748.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25491.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46822.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25741.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45605.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26741.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26741.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45351.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38547.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24992.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25991.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13106.93,"maximum":29561.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13106.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13897.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29561.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25126.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13500.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23648.9},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23034.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14162.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14162.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22905.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19469.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13235.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13764.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10329.24,"maximum":23296.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10329.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11227.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23296.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19801.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10906.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18637.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18152.83},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11441.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11441.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18051.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15343.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11120.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13289.46,"maximum":29972.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13289.46},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14072.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29972.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25476.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23978.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13804.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23355.17},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23224.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19740.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13402.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13938.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":35666.59,"10th_percentile":35666.59,"90th_percentile":35666.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8986.39,"maximum":20267.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8986.39},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20267.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17227.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9652.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16214.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15792.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10126.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10126.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15704.78},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13348.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9842.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":15701.41,"10th_percentile":15701.41,"90th_percentile":15701.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":18346.42,"10th_percentile":18346.42,"90th_percentile":18346.42},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":15704.78,"10th_percentile":15704.78,"90th_percentile":15704.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14823.46,"maximum":33473.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14841.63},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15564.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33473.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28452.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15119.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26778.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15268.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26082.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15861.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15861.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25937.51},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22046.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14823.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15416.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14271.2,"10th_percentile":14271.2,"90th_percentile":14271.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8238.91,"maximum":18581.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8238.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18581.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15794.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8955.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14865.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9042.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14479.24},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9394.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9394.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14398.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12238.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12581.82,"maximum":28376.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12581.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13392.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28376.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24120.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13009.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22701.43},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22111.55},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13647.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13647.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21988.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18689.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12754.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6226.81,"maximum":14043.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6226.81},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7284.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14043.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11937.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11235.06},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7145.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10943.12},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10882.08},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9249.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7215.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":11390.76,"10th_percentile":11390.76,"90th_percentile":11390.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10048.21,"maximum":22662.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10048.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10957.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22662.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19263.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10644.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18130.04},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17658.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17560.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14925.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10435.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10853.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18261.16,"maximum":41943.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18597.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19174.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41943.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35652.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33554.89},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18808.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32682.98},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19539.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19539.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32500.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27624.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18261.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18991.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10689.22,"maximum":24108.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10689.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11573.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24108.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20492.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19286.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18785.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18680.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15878.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11022.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11463.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13339.43,"maximum":30085.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13339.43},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30085.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25572.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13717.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24068.4},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13851.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23443.0},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14389.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14389.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23312.24},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19814.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13448.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7878.94,"maximum":17770.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7878.94},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17770.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15104.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8618.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14216.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8703.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13846.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9041.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9041.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13769.37},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11703.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8787.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6956.9,"maximum":15690.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6956.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7986.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15690.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13336.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7758.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12552.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7834.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12226.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8138.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8138.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12158.01},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10334.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7605.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7910.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10371.25,"maximum":23391.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10371.25},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11267.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23391.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19882.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10946.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18712.9},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18226.66},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11482.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11482.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18124.99},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15405.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10731.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11160.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7090.9,"maximum":15992.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7090.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8115.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15992.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13593.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12794.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7960.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12461.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12392.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10533.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8037.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7474.87,"10th_percentile":7474.87,"90th_percentile":7474.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4806.45,"maximum":10840.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4806.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5919.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10840.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9214.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5750.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8672.31},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5806.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8446.96},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8399.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7139.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5637.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5862.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7297.32,"maximum":16458.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7297.32},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8313.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16458.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13989.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8075.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13166.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12824.47},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8471.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8471.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12752.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10839.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7917.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":13450.24,"10th_percentile":13450.24,"90th_percentile":13450.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4132.13,"maximum":9319.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4132.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5271.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9319.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7921.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7455.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7261.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5371.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5371.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7221.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6138.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5221.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7761.6,"maximum":17505.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7761.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8759.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17505.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14879.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8509.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14004.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8592.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13640.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13564.31},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11529.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8342.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":5659.44,"10th_percentile":5659.44,"90th_percentile":13200.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":16459.45,"10th_percentile":12305.91,"90th_percentile":16459.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":16459.45,"10th_percentile":16459.45,"90th_percentile":16459.45},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5694.27,"10th_percentile":4915.46,"90th_percentile":5829.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":13073.38,"10th_percentile":13073.38,"90th_percentile":13564.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12239.22,"maximum":27604.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12239.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27604.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23463.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12690.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22083.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21509.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13312.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13312.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21389.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18180.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7262.56,"maximum":16379.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7262.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8280.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16379.84},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13922.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13103.87},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8122.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12763.37},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12692.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10788.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7885.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3995.2,"10th_percentile":3995.2,"90th_percentile":3995.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4741.99,"maximum":10695.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4741.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10695.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9090.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8556.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8333.68},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5968.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5968.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8287.19},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7043.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":1625.42,"10th_percentile":1625.42,"90th_percentile":1625.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":5877.0,"10th_percentile":4748.66,"90th_percentile":7340.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":7540.26,"10th_percentile":7540.26,"90th_percentile":7540.26},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3776.2,"10th_percentile":3776.2,"90th_percentile":3776.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":11294.98,"10th_percentile":11294.98,"90th_percentile":11294.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":5823.01,"10th_percentile":5823.01,"90th_percentile":5823.01},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6093.54,"maximum":13743.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6093.54},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13743.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11681.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10994.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7020.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10708.91},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10649.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9051.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6815.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3800.78,"10th_percentile":3800.78,"90th_percentile":3800.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17515.27,"maximum":40105.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17782.29},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18391.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40105.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34089.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17865.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32084.67},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18040.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31250.97},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18741.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18741.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31076.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26414.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17515.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18215.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":20575.35,"10th_percentile":20575.35,"90th_percentile":20575.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5754.44,"10th_percentile":5754.44,"90th_percentile":5754.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7678.3,"maximum":17317.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7678.3},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8679.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17317.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14719.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8431.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13854.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8514.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13494.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8844.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13418.75},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11405.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8266.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8596.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":5586.83,"10th_percentile":5586.83,"90th_percentile":5586.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":15125.0,"10th_percentile":15125.0,"90th_percentile":15662.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6937.35,"maximum":15646.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6937.35},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15646.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13299.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7739.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12517.09},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12191.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12123.83},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10304.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7588.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7891.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":4774.3,"10th_percentile":4774.3,"90th_percentile":4774.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":15413.16,"10th_percentile":9223.23,"90th_percentile":25815.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":15125.0,"10th_percentile":15125.0,"90th_percentile":25776.63},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5034.07,"10th_percentile":4917.53,"90th_percentile":5034.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":15967.53,"10th_percentile":15967.53,"90th_percentile":15967.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":10416.49,"10th_percentile":10416.49,"90th_percentile":10416.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11947.33,"maximum":26945.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11947.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12782.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26945.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22903.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21556.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12539.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20996.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13026.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13026.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20879.37},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17746.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12174.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":8228.86,"10th_percentile":8228.86,"90th_percentile":8228.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":2187.46,"10th_percentile":2187.46,"90th_percentile":2187.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":20578.48,"10th_percentile":20578.48,"90th_percentile":20578.48},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6608.85,"10th_percentile":6608.85,"90th_percentile":6608.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8088.98,"maximum":18243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8088.98},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9074.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18243.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15507.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8815.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14594.99},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14215.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14136.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12015.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8987.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":6416.36,"10th_percentile":6267.81,"90th_percentile":17166.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":15125.0,"10th_percentile":12856.25,"90th_percentile":19357.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5242.2,"10th_percentile":5242.2,"90th_percentile":6608.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":27694.19,"10th_percentile":27694.19,"90th_percentile":27694.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":15653.32,"10th_percentile":15653.32,"90th_percentile":15653.32},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6944.59,"maximum":15662.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6944.59},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7974.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15662.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13313.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7746.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12530.15},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7822.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12204.57},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12136.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10315.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7594.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7898.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":11567.92,"10th_percentile":11567.92,"90th_percentile":11567.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"13","median_amount":4971.69,"10th_percentile":4971.69,"90th_percentile":5993.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"27","median_amount":15125.0,"10th_percentile":2239.83,"90th_percentile":25388.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":15125.0,"10th_percentile":12856.25,"90th_percentile":28643.14},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"17","median_amount":5242.2,"10th_percentile":121.36,"90th_percentile":6608.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":15945.92,"10th_percentile":15945.92,"90th_percentile":15945.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":10788.55,"10th_percentile":10788.55,"90th_percentile":10788.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13053.33,"maximum":29440.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13053.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13845.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29440.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25024.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13450.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23552.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13582.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22940.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14109.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14109.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22812.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19389.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13186.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13713.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":2030.33,"10th_percentile":2030.33,"90th_percentile":2030.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40643.64,"maximum":97091.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43048.77},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42675.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":97091.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82527.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41456.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77673.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41862.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":75654.81},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43488.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43488.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75232.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63946.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40643.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42269.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5138.07,"10th_percentile":5138.07,"90th_percentile":5138.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28149.26,"maximum":66306.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29399.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29556.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":66306.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56360.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28712.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53045.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28993.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51667.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30119.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30119.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51378.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43670.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28149.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29275.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":1983.32,"10th_percentile":1983.32,"90th_percentile":5168.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":11615.58,"10th_percentile":11615.58,"90th_percentile":11615.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17476.16,"maximum":40009.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17739.56},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18349.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40009.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34008.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32007.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18000.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31175.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18699.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31001.97},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26350.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17476.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18175.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":1667.96,"10th_percentile":1629.35,"90th_percentile":2124.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":5970.39,"10th_percentile":5970.39,"90th_percentile":5970.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28882.54,"maximum":68113.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30200.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30326.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68113.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57896.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29460.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54490.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29749.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53074.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30904.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30904.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52778.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44860.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28882.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30037.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":11148.08,"10th_percentile":11148.08,"90th_percentile":11148.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":2030.33,"10th_percentile":2030.33,"90th_percentile":11249.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2143.45,"10th_percentile":2053.39,"90th_percentile":3396.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":6330.75,"10th_percentile":6330.75,"90th_percentile":6330.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10689.94,"maximum":24109.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10689.94},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11574.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24109.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20493.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19287.92},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18786.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18681.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15879.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11023.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":5524.25,"10th_percentile":5524.25,"90th_percentile":5524.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"26","median_amount":1667.96,"10th_percentile":1629.35,"90th_percentile":3297.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"47","median_amount":2042.82,"10th_percentile":1678.23,"90th_percentile":4109.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1447.15,"maximum":3263.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1447.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2690.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":3263.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2774.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2613.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2611.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2639.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":2543.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2741.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2741.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2529.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2149.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2562.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2664.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":2284.91,"10th_percentile":2284.91,"90th_percentile":2284.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"50","median_amount":1667.96,"10th_percentile":1629.35,"90th_percentile":1667.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"65","median_amount":1718.01,"10th_percentile":39.78,"90th_percentile":1718.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8452.58,"maximum":19063.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8452.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9423.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19063.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16204.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9154.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15251.03},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9244.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14854.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9603.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9603.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14771.89},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12555.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8975.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9334.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7245.9,"maximum":16342.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7245.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8264.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16342.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13890.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13073.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12734.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12663.06},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10763.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6932.28,"maximum":15634.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6932.28},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7962.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15634.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13289.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7735.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12507.94},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12182.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12114.97},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10297.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7583.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31264.73,"maximum":73982.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32802.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32827.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":73982.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62885.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31890.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59186.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32202.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57648.37},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33453.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33453.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57326.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48726.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31264.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32515.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19864.31,"maximum":45893.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20348.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20857.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45893.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39009.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20261.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36714.87},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35760.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21254.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21254.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35561.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30226.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20658.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13826.16,"maximum":31183.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13826.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31183.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26505.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14171.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24946.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14310.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24298.39},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14866.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14866.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24162.86},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20537.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13893.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14449.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27652.66,"maximum":65083.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28856.84},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29035.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":65083.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55320.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28205.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52066.53},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28482.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50713.61},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29588.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29588.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50430.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42864.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27652.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28758.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26508.19,"10th_percentile":26508.19,"90th_percentile":26508.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13464.01,"maximum":30366.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13464.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14240.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30366.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25811.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13833.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24293.18},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23661.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14511.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23529.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19999.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14104.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9821.51,"maximum":22151.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9821.51},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10739.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22151.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18828.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10432.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17720.99},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10535.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17260.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17164.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14589.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10228.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10637.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7816.65,"maximum":17629.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7816.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8812.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17629.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14985.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14103.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13737.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13660.51},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11611.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":10175.0,"10th_percentile":10175.0,"90th_percentile":10175.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":10175.0,"10th_percentile":10175.0,"90th_percentile":10175.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5461.22,"maximum":12317.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5461.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12317.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10469.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9853.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6423.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9597.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6673.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6673.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9544.13},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8112.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6486.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":9456.76,"10th_percentile":9456.76,"90th_percentile":9456.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":4951.84,"10th_percentile":4424.4,"90th_percentile":6042.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"12","median_amount":11833.76,"10th_percentile":9200.45,"90th_percentile":16032.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":10175.0,"10th_percentile":10175.0,"90th_percentile":15670.12},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":5100.4,"10th_percentile":4557.13,"90th_percentile":5100.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":11355.28,"10th_percentile":11355.28,"90th_percentile":11355.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":8628.93,"10th_percentile":8628.93,"90th_percentile":9544.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4883.23,"maximum":11013.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4883.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5993.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11013.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9361.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5821.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8810.84},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5879.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8581.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8534.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7253.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":7689.02,"10th_percentile":7288.16,"90th_percentile":25775.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"63","median_amount":4424.4,"10th_percentile":4321.96,"90th_percentile":4951.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"76","median_amount":10175.0,"10th_percentile":6255.91,"90th_percentile":16255.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"34","median_amount":11548.63,"10th_percentile":8393.58,"90th_percentile":18217.46},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"62","median_amount":4557.13,"10th_percentile":4451.62,"90th_percentile":5100.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"15","median_amount":9989.38,"10th_percentile":7935.38,"90th_percentile":11056.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":8103.62,"10th_percentile":8103.62,"90th_percentile":11019.88},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":7599.8,"10th_percentile":7253.72,"90th_percentile":8534.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":8534.02,"10th_percentile":8534.02,"90th_percentile":8534.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4986.89,"10th_percentile":4986.89,"90th_percentile":4986.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15876.32,"maximum":36067.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15991.82},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16670.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36067.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30657.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16193.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28854.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28104.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16987.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27947.6},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23754.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15876.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16511.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":29593.51,"10th_percentile":29593.51,"90th_percentile":29593.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":35219.98,"10th_percentile":35219.98,"90th_percentile":35219.98},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15552.25,"10th_percentile":15552.25,"90th_percentile":15567.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9168.91,"maximum":20679.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9168.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20679.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17577.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9823.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16543.52},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9919.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16113.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10304.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10304.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16023.76},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13619.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9630.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10016.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7580.52,"maximum":17096.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7580.52},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17096.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14532.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8340.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13677.58},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8422.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13322.17},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8749.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8749.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13247.86},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11260.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8176.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8503.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10171.34,"maximum":22940.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10171.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11075.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22940.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19499.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10759.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18352.21},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10864.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17875.33},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11286.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11286.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17775.63},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15108.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10548.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10970.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":26008.43,"10th_percentile":26008.43,"90th_percentile":26008.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":23738.0,"10th_percentile":23738.0,"90th_percentile":23738.0},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":19909.28,"10th_percentile":19909.28,"90th_percentile":19909.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9883.44,"10th_percentile":1665.0,"90th_percentile":10147.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3252.73,"10th_percentile":3252.73,"90th_percentile":3252.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6650.52,"maximum":14999.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6650.52},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14999.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12749.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11999.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11687.77},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7838.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7838.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11622.58},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9878.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7325.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7618.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":4940.2,"10th_percentile":4940.2,"90th_percentile":4940.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":12858.94,"10th_percentile":12858.94,"90th_percentile":12858.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6820.92,"10th_percentile":6817.19,"90th_percentile":7106.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5744.69,"10th_percentile":5744.69,"90th_percentile":5766.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11047.75,"maximum":24916.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11047.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11918.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24916.89},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21179.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11577.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19933.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11691.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19415.54},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12145.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12145.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19307.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16410.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11350.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10792.63,"10th_percentile":10792.63,"90th_percentile":10792.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15337.96,"maximum":34741.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15403.69},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16104.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34741.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29530.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27792.95},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15798.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27070.76},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16411.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16411.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26919.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22881.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15337.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15951.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7344.4,"maximum":16564.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7344.4},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16564.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14079.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13251.54},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12907.21},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12835.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10909.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7960.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8279.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4577.58,"maximum":10324.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4577.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5699.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10324.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8775.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5536.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8259.34},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5590.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8044.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5807.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5807.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7999.86},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6799.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5427.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5645.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16364.96,"maximum":37271.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16525.63},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17183.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37271.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31680.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29817.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16855.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29042.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17510.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17510.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28880.49},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24547.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16364.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8396.09,"maximum":18936.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8396.09},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9369.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18936.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16095.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9101.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15149.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14755.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9548.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9548.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14673.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12471.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8923.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6228.26,"maximum":14047.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6228.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7285.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14047.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11940.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11237.67},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7147.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10945.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10884.61},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9251.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6938.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40121.85,"maximum":95805.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42478.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42127.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":95805.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81434.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40924.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76644.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41325.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":74653.04},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42930.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42930.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74236.64},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63099.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40121.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41726.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16079.86,"maximum":36569.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16214.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36569.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31083.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16401.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29255.32},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16562.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28495.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17205.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17205.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28336.2},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24085.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16079.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16723.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8720.57,"maximum":19668.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8720.57},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19668.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16717.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9404.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15734.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9496.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15325.72},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15240.23},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12953.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9589.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31635.35,"maximum":74896.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33207.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33217.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":74896.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63661.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32268.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59916.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32584.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58359.92},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33849.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33849.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58034.4},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49327.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31635.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32900.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16258.88,"maximum":37010.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16409.74},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17071.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37010.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31458.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16584.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29608.17},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16746.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28838.82},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17397.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17397.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28677.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24375.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16258.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16909.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9773.7,"maximum":22043.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9773.7},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10693.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22043.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18736.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17634.74},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17176.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10897.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10897.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17080.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14518.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10184.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10591.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32251.95,"maximum":76415.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33881.31},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33864.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":76415.28},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64952.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32896.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61132.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33219.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59543.72},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34509.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34509.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59211.59},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50328.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32251.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33542.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16561.21,"maximum":37755.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16740.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17389.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37755.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32091.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16892.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30204.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17058.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29419.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17720.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17720.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29255.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24866.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16561.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17223.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6056.6,"maximum":13659.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6056.6},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13659.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11610.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6917.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10927.95},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6985.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10643.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7256.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7256.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10584.62},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8996.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13985.51,"maximum":31542.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13985.51},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14741.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31542.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26811.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14320.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25234.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14460.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24578.43},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24441.33},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20774.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14039.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14601.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8743.75,"maximum":19720.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8743.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9703.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19720.49},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16762.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9426.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15776.39},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9518.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15366.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9888.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9888.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15280.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12988.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9241.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9611.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6331.11,"maximum":14279.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6331.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7384.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14279.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12137.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7173.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11423.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7244.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11126.42},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11064.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9404.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12139.99,"maximum":27380.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12139.99},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12967.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27380.32},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23273.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12597.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21904.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12720.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21335.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21216.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18033.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12350.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12844.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9380.12,"10th_percentile":9380.12,"90th_percentile":9380.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6962.7,"maximum":15703.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6962.7},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7991.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15703.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13348.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12562.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12236.39},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8144.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8144.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12168.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10342.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7611.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7915.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":31946.27,"10th_percentile":31946.27,"90th_percentile":31946.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":9769.08,"10th_percentile":9769.08,"90th_percentile":9769.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7325.54,"10th_percentile":250.58,"90th_percentile":7367.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9389.1,"maximum":21176.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9389.1},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21176.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17999.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16940.8},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10127.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16500.6},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10520.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10520.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16408.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13946.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10225.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9277.16,"10th_percentile":9277.16,"90th_percentile":9277.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6012.41,"maximum":13560.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6012.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13560.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11526.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10848.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10566.34},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7213.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7213.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10507.41},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8931.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":30639.31,"10th_percentile":30639.31,"90th_percentile":30639.31},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6822.25,"10th_percentile":6822.25,"90th_percentile":6822.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9573.8,"maximum":21592.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9573.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21592.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18353.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17274.05},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10301.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16825.19},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16731.34},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14221.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9613.26,"10th_percentile":9613.26,"90th_percentile":9613.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6016.04,"maximum":13568.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6016.04},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13568.46},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11533.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6879.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10854.76},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6947.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10572.71},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10513.73},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8936.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6744.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":11139.62,"10th_percentile":11139.62,"90th_percentile":11139.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":12496.46,"10th_percentile":12496.46,"90th_percentile":12496.46},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10769.62,"maximum":24289.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10769.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11650.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24289.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20646.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19431.67},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11428.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18926.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11872.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11872.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18821.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15997.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11096.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10733.45,"10th_percentile":10733.45,"90th_percentile":10733.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7290.24,"10th_percentile":7290.24,"90th_percentile":7290.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6469.45,"maximum":14591.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6469.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7517.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14591.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12402.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7302.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11672.86},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11369.54},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11306.13},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9609.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7159.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7446.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":8806.51,"10th_percentile":8806.51,"90th_percentile":8806.51},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6448.79,"10th_percentile":6448.79,"90th_percentile":6448.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13507.47,"maximum":30464.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13507.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14282.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30464.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25894.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13874.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24371.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14010.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23738.31},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23605.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20064.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13602.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12751.31,"10th_percentile":12751.31,"90th_percentile":12751.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8156.34,"maximum":18395.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8156.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18395.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15636.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8877.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14716.53},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8965.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14334.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9313.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9313.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14254.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12115.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9052.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5822.65,"maximum":13132.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5822.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13132.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11162.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6699.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10505.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6764.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10232.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7027.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7027.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10175.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8649.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6567.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10319.83,"maximum":23275.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10319.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23275.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19783.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10898.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18620.11},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11004.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18136.28},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11432.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11432.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18035.12},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15329.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11111.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.58,"10th_percentile":251.58,"90th_percentile":251.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8287.54,"10th_percentile":8287.54,"90th_percentile":8287.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6486.11,"maximum":14628.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6486.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14628.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12434.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11702.91},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11398.82},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11335.24},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9634.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":8360.73,"10th_percentile":8360.73,"90th_percentile":8360.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11180.29,"maximum":25215.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11180.29},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12045.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25215.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21433.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11701.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20172.66},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11816.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19648.48},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12275.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19538.89},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16607.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11471.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11930.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10923.74,"10th_percentile":10923.74,"90th_percentile":10923.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9579.76,"10th_percentile":9579.76,"90th_percentile":9579.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7057.58,"maximum":15917.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7057.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15917.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13529.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7852.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12734.02},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12403.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8236.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8236.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12333.96},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10483.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8006.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2000.0,"10th_percentile":2000.0,"90th_percentile":2000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5540.06,"10th_percentile":5540.06,"90th_percentile":5540.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5427.18,"maximum":12240.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5427.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6515.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12240.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10404.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9792.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9537.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6640.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6640.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9484.64},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8061.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20737.49,"maximum":48045.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21302.39},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":48045.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40838.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21152.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38436.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21359.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37437.26},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37228.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31643.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20737.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21566.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12237.05,"maximum":27599.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12237.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13061.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27599.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23459.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12688.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22079.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12812.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21505.65},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13310.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13310.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21385.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18177.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12439.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12936.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8302.65,"maximum":18725.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8302.65},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18725.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15916.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9014.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14980.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14591.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9456.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9456.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14509.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12333.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8837.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44674.06,"maximum":107021.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47451.79},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46907.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":107021.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90968.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45567.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85617.5},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46014.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":83392.77},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82927.62},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70486.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44674.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46461.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24253.42,"maximum":56707.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25143.35},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25466.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56707.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48201.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24738.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45366.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24981.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44187.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25951.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25951.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43940.98},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37348.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24253.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25223.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13015.67,"maximum":29355.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13015.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13809.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29355.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24952.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13415.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23484.24},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13546.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22874.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14072.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14072.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22746.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19333.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13152.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13678.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33733.11,"maximum":80064.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35499.39},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35419.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":80064.68},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68054.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34407.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64051.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34745.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":62387.37},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36094.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36094.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62039.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52732.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33733.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35082.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18812.12,"maximum":43301.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19199.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19752.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43301.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36805.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19188.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34640.89},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19376.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33740.76},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20128.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20128.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33552.56},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28518.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18812.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19564.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11635.16,"maximum":26241.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11635.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12482.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26241.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22305.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12126.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20993.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12244.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20447.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12720.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12720.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20333.81},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17283.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12363.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22709.28,"maximum":52903.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23456.46},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23844.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52903.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44967.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42322.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23390.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41222.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24298.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24298.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40992.93},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34843.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22709.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23617.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12515.9,"maximum":28228.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12515.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13329.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28228.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23993.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12948.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22582.51},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13075.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21995.71},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13583.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13583.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21873.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18591.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12694.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13202.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2071.03,"10th_percentile":2071.03,"90th_percentile":2071.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10452.37,"maximum":23574.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10452.37},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11345.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23574.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20037.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11021.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18859.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11129.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18369.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11562.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11562.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18266.76},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15526.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10805.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11237.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13954.36,"maximum":31472.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13954.36},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31472.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26751.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14291.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25177.93},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14431.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24523.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24386.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20728.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14571.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12489.83,"maximum":28169.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12489.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13304.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28169.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23943.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12924.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22535.46},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21949.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13557.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13557.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21827.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18552.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12670.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13177.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15430.78,"maximum":34969.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15505.09},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16202.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34969.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29724.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15739.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27975.91},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15893.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27248.97},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16510.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16510.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27096.98},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23031.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15430.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16048.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13972.47,"maximum":31513.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13972.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31513.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26786.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14308.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25210.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14448.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24555.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24418.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20755.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14027.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14017.38,"maximum":31614.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14017.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14772.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31614.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26872.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14350.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25291.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24634.43},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24497.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20821.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14631.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8592.37,"maximum":19379.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8592.37},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9558.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19379.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16472.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9285.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15503.26},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15100.41},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9740.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15016.19},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12763.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9467.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6278.23,"maximum":14159.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6278.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14159.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12035.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7124.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11327.85},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7194.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11033.5},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7473.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7473.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10971.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9325.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6984.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7264.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15298.18,"maximum":34643.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15360.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16063.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34643.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29446.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15604.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27714.54},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15757.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26994.39},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16369.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16369.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26843.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22816.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15298.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15910.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7840.55,"maximum":17683.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7840.55},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8835.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17683.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15030.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14146.74},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8667.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13779.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13702.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11646.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8751.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":10626.15,"10th_percentile":10626.15,"90th_percentile":10626.15},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12074.81,"maximum":27233.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12074.81},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27233.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23148.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12536.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21786.63},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21220.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13151.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13151.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21102.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17936.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12290.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12782.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10985.55,"10th_percentile":10985.55,"90th_percentile":10985.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8194.01,"maximum":18480.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8194.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9175.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18480.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15708.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14784.48},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9000.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14400.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9350.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9350.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14320.0},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12171.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9087.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5572.76,"maximum":12568.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5572.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12568.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10683.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10054.97},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6529.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9793.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9739.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8277.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6592.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7544.31,"maximum":17015.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7544.31},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17015.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14463.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13612.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8387.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13258.53},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8713.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13184.57},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11206.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8143.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4382.02,"maximum":9883.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4382.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5511.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9883.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8400.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7906.49},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5406.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7701.05},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5616.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5616.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7658.09},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6509.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5458.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10294.48,"maximum":23217.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10294.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11194.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23217.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19735.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18574.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18091.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17990.82},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15291.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10661.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11087.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10221.66,"10th_percentile":10221.66,"90th_percentile":10221.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10276.19,"10th_percentile":10265.16,"90th_percentile":10315.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8835.78,"10th_percentile":8835.78,"90th_percentile":8835.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6307.93,"maximum":14226.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6307.93},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7362.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14226.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12092.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7152.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11381.43},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7222.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11085.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7502.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7502.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11023.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9370.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":2716.49,"10th_percentile":2716.49,"90th_percentile":2716.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":14452.22,"10th_percentile":14393.72,"90th_percentile":25482.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6692.52,"10th_percentile":6692.52,"90th_percentile":6692.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6778.67,"10th_percentile":6352.56,"90th_percentile":6798.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4599.0,"10th_percentile":4599.0,"90th_percentile":4599.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10662.42,"maximum":24047.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10662.42},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24047.83},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20440.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11217.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19238.26},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18738.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18633.84},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15838.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10997.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11437.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6634.59,"maximum":14963.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6634.59},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7676.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14963.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12719.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7457.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11970.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7530.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11659.76},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7822.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7822.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11594.73},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9855.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7310.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7603.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10960.11,"maximum":24719.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10960.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24719.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21011.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11495.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19775.38},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19261.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12059.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12059.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19154.09},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16280.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11721.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6565.06,"maximum":14806.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6565.06},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14806.71},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12585.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7392.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11845.36},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11537.57},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11473.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9751.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7247.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.58,"10th_percentile":251.58,"90th_percentile":251.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15769.58,"maximum":35804.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15875.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16558.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35804.65},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30433.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28643.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16242.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27899.42},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16873.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16873.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27743.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23581.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15769.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16400.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10135.13,"maximum":22858.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10135.13},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11041.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22858.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19429.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10725.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18286.86},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10830.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17811.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11251.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11251.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17712.34},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15055.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10935.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24359.5,"maximum":56969.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25259.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25577.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56969.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48423.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24846.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45575.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25090.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44391.11},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26064.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26064.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44143.51},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37520.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24359.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25333.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13546.58,"maximum":30552.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13546.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30552.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25969.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24442.17},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14047.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23807.05},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14592.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14592.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23674.26},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20122.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14183.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":34053.29,"10th_percentile":26815.36,"90th_percentile":35111.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1955.0,"10th_percentile":1955.0,"90th_percentile":1955.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10272.75,"maximum":23168.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10272.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11173.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23168.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19693.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10854.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18535.17},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18053.54},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17952.84},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15259.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10641.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11066.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20381.46,"maximum":47167.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20913.44},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21400.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47167.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40092.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20789.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37734.22},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20992.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36753.71},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21808.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21808.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36548.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31065.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21196.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11590.97,"maximum":26142.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11590.97},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12440.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26142.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22220.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20913.65},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12203.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20370.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12677.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12677.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20256.6},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17217.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12321.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10925.34,"maximum":24640.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10925.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11800.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24640.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20944.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11463.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19712.65},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11575.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19200.42},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12025.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12025.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19093.33},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16228.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11688.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24835.54,"maximum":58142.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25779.29},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26077.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":58142.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49420.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25332.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46513.69},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25580.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45305.06},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26574.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26574.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45052.35},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38293.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24835.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25828.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12993.22,"maximum":29304.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12993.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29304.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24908.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23443.73},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13525.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22834.55},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14050.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14050.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22707.19},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19300.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":27705.58,"10th_percentile":27705.58,"90th_percentile":27705.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9067.51,"maximum":20450.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9067.51},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20450.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17383.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9728.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16360.56},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15935.44},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15846.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13469.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9537.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9919.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21261.27,"maximum":49335.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21874.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22324.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49335.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41935.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21686.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39468.42},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21899.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38442.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22749.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22749.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38228.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32493.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21261.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22111.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19190.39,"10th_percentile":19190.39,"90th_percentile":19190.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10860.15,"maximum":24493.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10860.15},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11737.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24493.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20819.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19595.03},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11514.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19085.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11961.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11961.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18979.41},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16132.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11178.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11626.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9620.88,"maximum":21698.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9620.88},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21698.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18443.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10245.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17358.99},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16907.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16813.62},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14291.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25946.75,"maximum":60880.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26993.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27244.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":60880.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51748.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26465.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48703.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26725.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47438.44},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47173.83},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40096.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25946.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26984.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15683.38,"maximum":35592.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15781.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16467.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35592.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30253.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15997.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28473.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16153.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27733.95},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16781.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16781.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27579.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23441.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15683.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16310.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20116.74,"10th_percentile":20116.74,"90th_percentile":20116.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15309.39,"10th_percentile":15309.39,"90th_percentile":15309.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10571.16,"maximum":23842.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10571.16},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23842.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20265.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19073.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18577.98},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11678.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11678.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18474.35},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15702.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11350.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":21316.26,"10th_percentile":21316.26,"90th_percentile":21316.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10406.02,"maximum":23469.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10406.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23469.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19949.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18775.63},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18287.75},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11516.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11516.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18185.75},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15457.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10763.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11193.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":19583.52,"10th_percentile":19583.52,"90th_percentile":19583.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10252.23,"10th_percentile":10252.23,"90th_percentile":10252.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10222.99,"10th_percentile":10199.84,"90th_percentile":10378.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9891.97,"10th_percentile":9891.97,"90th_percentile":9891.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6491.18,"maximum":14640.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6491.18},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14640.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12444.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7323.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11712.06},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7395.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11407.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7682.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7682.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11344.1},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9642.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7179.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7466.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":10489.1,"10th_percentile":10489.1,"90th_percentile":11946.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":11182.08,"10th_percentile":11182.08,"90th_percentile":11623.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":10330.09,"10th_percentile":10330.09,"90th_percentile":14400.89},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":12768.87,"10th_percentile":12768.87,"90th_percentile":12768.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5018.4,"10th_percentile":251.58,"90th_percentile":5907.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7093.65,"10th_percentile":7093.65,"90th_percentile":7093.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4499.35,"maximum":10147.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4499.35},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10147.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8625.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5463.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8118.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5517.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7907.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7863.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6683.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5356.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5570.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":12515.25,"10th_percentile":12515.25,"90th_percentile":12515.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":8411.47,"10th_percentile":8411.47,"90th_percentile":9526.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":4942.05,"10th_percentile":4942.05,"90th_percentile":4942.05},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":6203.93,"10th_percentile":6203.93,"90th_percentile":6203.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9673.75,"maximum":21818.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9673.75},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10597.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21818.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18545.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10294.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17454.4},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10395.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17000.85},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16906.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14369.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10092.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":5018.53,"10th_percentile":5018.53,"90th_percentile":5018.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":16288.89,"10th_percentile":16288.89,"90th_percentile":16288.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"33","median_amount":9389.29,"10th_percentile":350.0,"90th_percentile":9734.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8527.85,"10th_percentile":6701.68,"90th_percentile":9854.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5636.5,"maximum":12712.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5636.5},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6717.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12712.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10805.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6525.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10169.97},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6589.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9905.71},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6845.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6845.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9850.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8372.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6397.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":8936.09,"10th_percentile":8936.09,"90th_percentile":8936.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":18145.75,"10th_percentile":18145.75,"90th_percentile":18145.75},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":9318.2,"10th_percentile":9318.2,"90th_percentile":9318.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5896.04,"10th_percentile":251.28,"90th_percentile":6195.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4780.99,"10th_percentile":4780.99,"90th_percentile":5194.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10300.27,"maximum":23231.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10300.27},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11199.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23231.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19746.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10879.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18584.83},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18101.91},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18000.94},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15300.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10666.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11922.7,"maximum":26890.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11922.7},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12759.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26890.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22856.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12394.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21512.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20953.21},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13002.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13002.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20836.33},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17710.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12151.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12637.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":14685.11,"10th_percentile":14685.11,"90th_percentile":14685.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11711.28,"10th_percentile":11711.28,"90th_percentile":11711.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7424.08,"maximum":16744.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7424.08},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16744.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14232.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8194.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13395.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8274.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13047.23},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8595.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8595.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12974.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11027.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":2386.23,"10th_percentile":2386.23,"90th_percentile":2386.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7524.32,"10th_percentile":6511.6,"90th_percentile":7527.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6372.82,"10th_percentile":6372.82,"90th_percentile":6372.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5564.8,"maximum":12550.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5564.8},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12550.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10668.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10040.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6521.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9779.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9725.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8266.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6584.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":9286.0,"10th_percentile":9286.0,"90th_percentile":9286.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6140.77,"10th_percentile":6140.77,"90th_percentile":6140.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32408.42,"maximum":76800.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34052.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34028.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":76800.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65280.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33056.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61440.62},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33380.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59844.12},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59510.32},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50582.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32408.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33704.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25807.51,"maximum":60536.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26841.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27097.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":60536.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51456.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26323.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48429.54},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47171.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27614.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27614.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46908.02},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39870.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25807.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26839.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22649.61,"maximum":52756.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23391.27},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23782.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52756.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44842.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23102.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42204.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23329.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41108.31},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24235.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24235.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40879.01},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34746.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22649.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23555.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35690.31,"maximum":84886.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37637.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37474.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":84886.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72153.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36404.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67909.57},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36761.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":66144.98},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38188.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38188.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65776.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55908.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35690.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37117.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19797.35,"maximum":45728.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20275.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20787.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":45728.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38869.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20193.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36582.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20391.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35632.29},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21183.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21183.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35433.54},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30117.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19797.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20589.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15270.99,"maximum":34576.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15330.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34576.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29389.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27660.96},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15729.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26942.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16339.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16339.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26791.92},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22772.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15270.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15881.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22346.61,"maximum":52009.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23060.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23463.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52009.7},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44208.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22793.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41607.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23017.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40526.59},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23910.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23910.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40300.54},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34254.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22346.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13254.69,"maximum":29894.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13254.69},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14039.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29894.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25410.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13638.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23915.5},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23294.07},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14306.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14306.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23164.14},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19688.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13370.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11239.69,"maximum":25349.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11239.69},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12102.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25349.79},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21547.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20279.82},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11872.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19752.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12333.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12333.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19642.68},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16695.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11526.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11987.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9194.26,"maximum":20736.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9194.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10136.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20736.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17626.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9847.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16589.26},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9943.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16158.19},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10329.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10329.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16068.07},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13657.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10040.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9140.37,"10th_percentile":9140.37,"90th_percentile":9140.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5798.02,"maximum":13076.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5798.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13076.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11115.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10461.4},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10189.56},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10132.73},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8612.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6545.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6806.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":21662.32,"10th_percentile":21662.32,"90th_percentile":21662.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.58,"10th_percentile":251.58,"90th_percentile":251.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4269.51,"10th_percentile":4269.51,"90th_percentile":4269.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8617.0,"maximum":19434.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8617.0},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9581.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19434.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16519.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15547.69},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15143.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9764.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9764.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15059.22},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12799.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9125.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4546.43,"maximum":10253.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4546.43},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5669.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10253.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8715.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5507.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8203.15},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5561.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7989.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5777.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5777.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7945.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6753.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5399.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5615.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4027.11,"maximum":9082.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4027.11},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9082.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7720.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5022.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7266.13},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5071.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7077.32},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5268.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5268.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7037.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5982.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4924.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5121.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45865.49,"maximum":109957.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48753.36},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48158.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":109957.43},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93463.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46782.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87965.92},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47241.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":85680.17},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49076.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49076.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85202.26},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72419.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45865.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47700.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26186.75,"maximum":61471.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27255.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27496.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61471.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52250.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26710.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49177.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47899.23},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28019.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28019.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47632.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40486.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26186.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27234.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51758.3,"maximum":124476.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55190.94},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54346.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":124476.63},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105805.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52793.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99581.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53311.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":96993.71},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55381.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55381.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96452.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81982.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51758.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53828.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17197.45,"10th_percentile":17197.45,"90th_percentile":17197.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29176.26,"maximum":68837.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30521.28},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30635.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68837.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58511.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55069.69},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30051.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53638.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31218.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31218.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53339.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45337.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29176.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30343.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20757.38,"maximum":48094.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21324.12},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21795.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":48094.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40879.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21172.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38475.21},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21380.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37475.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22210.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22210.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37266.42},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31675.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20757.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21587.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19363.08,"maximum":44658.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19800.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20331.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44658.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37959.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19750.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35726.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19943.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34798.54},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20718.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20718.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34604.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29412.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19363.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20137.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11100.62,"maximum":25036.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11100.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25036.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21280.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20028.91},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19508.47},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12196.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12196.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19399.65},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16489.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11399.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6812.04,"maximum":15363.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6812.04},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7847.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15363.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13059.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12291.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11971.62},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11904.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10118.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7473.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7772.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41822.47,"maximum":99995.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44336.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43913.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":99995.9},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84996.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42658.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79996.7},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43077.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":77918.03},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44750.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44750.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77483.42},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65859.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41822.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43495.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18723.94,"maximum":43083.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19102.69},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19660.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43083.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36621.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19098.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34467.07},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19285.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33571.46},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20034.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20034.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33384.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28375.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18723.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19472.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20372.18,"maximum":47144.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20903.3},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21390.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47144.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40073.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20779.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37715.92},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20983.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36735.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21798.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21798.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36530.99},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31050.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20372.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21187.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1757.38,"10th_percentile":1757.38,"90th_percentile":1757.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19990.81,"10th_percentile":19990.81,"90th_percentile":19990.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19108.46,"10th_percentile":19108.46,"90th_percentile":19108.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9379.69,"maximum":21154.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9379.69},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21154.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17981.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16923.81},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10118.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16484.06},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10511.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10511.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16392.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13932.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9823.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10216.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6538.26,"maximum":14746.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6538.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7583.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14746.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12534.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7367.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11797.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7439.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11490.47},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11426.38},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9712.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7222.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9399.24,"maximum":21198.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9399.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21198.88},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18019.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10038.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16959.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10136.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16518.42},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10530.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10530.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16426.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13961.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9841.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10235.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32344.77,"maximum":76643.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33982.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33962.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":76643.98},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65147.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32991.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61315.16},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33315.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59721.92},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34608.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34608.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59388.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50479.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32344.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33638.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30981.55,"10th_percentile":30981.55,"90th_percentile":30981.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":75564.66,"10th_percentile":75564.66,"90th_percentile":75564.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31331.58,"10th_percentile":31034.45,"90th_percentile":31929.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17537.82,"maximum":40161.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17806.92},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18414.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40161.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34137.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32129.1},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18063.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31294.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31119.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26451.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17537.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18239.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":30147.51,"10th_percentile":30147.51,"90th_percentile":30147.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15239.17,"10th_percentile":15239.17,"90th_percentile":15239.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16534.25,"10th_percentile":16534.25,"90th_percentile":16534.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12414.5,"maximum":27999.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12414.5},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13231.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27999.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23799.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22399.55},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21817.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13483.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13483.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21695.81},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18440.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12601.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13105.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":22414.68,"10th_percentile":22414.68,"90th_percentile":22414.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12135.67,"10th_percentile":12135.67,"90th_percentile":12135.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23968.33,"maximum":56005.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24831.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25166.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56005.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47604.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24447.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44804.32},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43640.1},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25646.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25646.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43396.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36886.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23968.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24927.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2770.57,"10th_percentile":2770.57,"90th_percentile":2770.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13607.91,"10th_percentile":13607.91,"90th_percentile":13607.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11904.59,"maximum":26849.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11904.59},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12741.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26849.41},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22821.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12377.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21479.52},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12499.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20921.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12984.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12984.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20804.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17683.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12620.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11540.01,"10th_percentile":11540.01,"90th_percentile":11540.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12340.62,"maximum":27832.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12340.62},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13160.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27832.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23657.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12784.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22266.25},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12910.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21687.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13411.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13411.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21566.7},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18331.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12534.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13035.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10036.93,"10th_percentile":10036.93,"90th_percentile":10036.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22188.82,"maximum":51620.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22887.88},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23298.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51620.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43877.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22632.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41296.71},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22854.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40223.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39999.28},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33998.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22188.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23076.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20649.15,"10th_percentile":20649.15,"90th_percentile":20649.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10900.72,"maximum":24585.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10900.72},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11776.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24585.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20897.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11440.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19668.21},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11552.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19157.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12001.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12001.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19050.29},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16192.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11216.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8709.71,"maximum":19643.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8709.71},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9670.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19643.72},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16697.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9394.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15714.97},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15306.62},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9855.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9855.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15221.25},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12937.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9578.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5226.55,"maximum":11787.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5226.55},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6323.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11787.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10019.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9430.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6202.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9185.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6443.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9134.01},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7763.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":7843.26,"10th_percentile":7843.26,"90th_percentile":9968.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4026.56,"10th_percentile":4026.56,"90th_percentile":4026.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":11270.18,"10th_percentile":11270.18,"90th_percentile":11270.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3787.36,"maximum":8541.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3787.36},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4939.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8541.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7260.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4798.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6833.56},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":6655.99},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5033.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5033.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6618.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5625.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4704.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4892.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":3161.67,"10th_percentile":2792.03,"90th_percentile":3236.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":6915.65,"10th_percentile":6915.65,"90th_percentile":6915.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":4034.51,"10th_percentile":4034.51,"90th_percentile":4034.51},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3333.71,"10th_percentile":3333.71,"90th_percentile":3333.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":7633.66,"10th_percentile":7633.66,"90th_percentile":7633.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37636.24,"maximum":89681.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39763.35},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39518.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":89681.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76229.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38388.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71745.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38765.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":69880.94},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40270.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40270.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69491.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59065.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37636.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39141.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15066.79,"maximum":34073.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15107.45},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15820.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34073.07},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28962.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15368.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27258.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15518.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26550.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16121.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16121.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26402.06},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22441.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8832.84,"maximum":19921.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8832.84},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19921.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16933.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9509.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15937.13},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9602.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15523.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15436.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13120.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9323.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33090.65,"maximum":78481.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34797.54},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":78481.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66709.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33752.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62785.38},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34083.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":61153.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60812.83},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51689.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33090.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34414.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15077.4,"maximum":34099.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15119.04},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15831.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34099.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28984.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15378.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27279.35},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15529.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26570.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16132.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16132.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26422.31},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22458.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15077.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15680.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10458.17,"maximum":23587.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10458.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23587.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20049.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18869.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18379.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18276.89},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15534.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10810.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22685.41,"maximum":52844.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23430.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23819.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52844.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44917.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23139.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42275.55},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23365.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41177.04},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24273.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24273.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40947.36},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34804.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22685.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23592.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1520.39,"10th_percentile":1520.39,"90th_percentile":1520.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11816.23,"maximum":26650.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11816.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12656.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26650.11},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22652.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12295.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21320.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12415.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20766.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12897.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12897.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20650.26},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17552.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12536.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":6755.0,"10th_percentile":6755.0,"90th_percentile":6755.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":250.08,"10th_percentile":250.08,"90th_percentile":250.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7318.33,"maximum":16505.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7318.33},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8333.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16505.62},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14029.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8095.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13204.49},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12861.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12789.64},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10870.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7936.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8254.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14448.34,"maximum":32586.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14448.34},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32586.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27698.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14752.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26069.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14897.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25391.81},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15475.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15475.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25250.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21462.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14463.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8817.63,"maximum":19887.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8817.63},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19887.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16904.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15909.69},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9588.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15496.28},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9960.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9960.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15409.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13098.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6168.14,"maximum":13911.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.14},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13911.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11824.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11129.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7090.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10840.02},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10779.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9162.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7159.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18426.25,"maximum":42350.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18777.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19347.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":42350.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35997.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18794.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33880.29},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18979.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32999.93},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19716.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19716.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32815.87},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27892.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18426.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19163.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9475.29,"maximum":21370.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9475.29},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10406.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21370.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18164.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10109.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17096.32},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10208.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16652.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16559.2},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14074.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9911.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10307.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6152.2,"maximum":13875.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6152.2},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13875.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11794.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11100.45},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7075.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10812.01},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10751.71},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9138.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6869.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7144.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19201.97,"maximum":44261.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19624.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20162.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":44261.66},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37622.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19586.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35409.32},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19778.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34489.23},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20546.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20546.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34296.85},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29151.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19201.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19970.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58650.93,"maximum":141459.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62720.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61583.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":141459.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120240.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59823.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113167.37},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60410.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":110226.78},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62756.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62756.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109611.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93167.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58650.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60996.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33981.07,"maximum":80675.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35770.28},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35680.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":80675.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68574.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34660.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64540.49},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35000.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":62863.44},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36359.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36359.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62512.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53134.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35340.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":4158.71,"10th_percentile":2459.63,"90th_percentile":45127.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32293.94,"10th_percentile":30631.37,"90th_percentile":38738.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":56919.66,"10th_percentile":56919.66,"90th_percentile":56919.66},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":165281.74,"10th_percentile":165281.74,"90th_percentile":165281.74},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":32565.42,"10th_percentile":1770.0,"90th_percentile":32917.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23339.06,"10th_percentile":23339.06,"90th_percentile":33302.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14472.24,"maximum":32640.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14472.24},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15209.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32640.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27744.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14775.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26112.33},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14919.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25433.81},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15499.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15499.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25291.95},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21497.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14485.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15064.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":24311.99,"10th_percentile":7380.59,"90th_percentile":55939.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13582.74,"10th_percentile":13582.74,"90th_percentile":13582.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":13036.3,"10th_percentile":13036.3,"90th_percentile":13036.3},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":26691.59,"10th_percentile":26691.59,"90th_percentile":26691.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1225.0,"10th_percentile":1225.0,"90th_percentile":2345.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10844.22,"maximum":24457.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10844.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11722.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24457.85},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20789.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11387.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19566.28},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11499.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19057.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11945.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11945.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18951.56},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16108.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11164.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11610.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31396.01,"maximum":74306.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32946.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32965.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":74306.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63160.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32023.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59445.05},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32337.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":57900.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33593.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33593.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57577.44},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48939.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31396.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32651.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":88424.03,"10th_percentile":88424.03,"90th_percentile":88424.03},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30117.93,"10th_percentile":30117.93,"90th_percentile":30117.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15436.08,"maximum":34982.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15510.88},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16207.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34982.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29735.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27986.36},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15899.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27259.15},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16516.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16516.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27107.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23040.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15436.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16053.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10088.77,"maximum":22754.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10088.77},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22754.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19340.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10682.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18203.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10786.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17730.22},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11205.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11205.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17631.33},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14986.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10472.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10891.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13209.06,"maximum":29791.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13209.06},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13995.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29791.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25322.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13595.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23833.17},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13728.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23213.88},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14262.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14262.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23084.39},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19621.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13329.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":22048.27,"10th_percentile":22048.27,"90th_percentile":22048.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":18434.41,"10th_percentile":18434.41,"90th_percentile":18434.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12662.47,"10th_percentile":12662.47,"90th_percentile":12662.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7227.79,"maximum":16301.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7227.79},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8246.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16301.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13856.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13041.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8089.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12702.27},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8403.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12631.42},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10736.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8168.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3186.6,"10th_percentile":3186.6,"90th_percentile":3186.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6429.61,"maximum":14501.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6429.61},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14501.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12326.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7265.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11600.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11299.53},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11236.51},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9550.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10852.19,"maximum":24475.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10852.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11730.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24475.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20804.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19580.65},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11506.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19071.86},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11953.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11953.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18965.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16120.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11618.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":22158.98,"10th_percentile":22158.98,"90th_percentile":22158.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6298.51,"maximum":14205.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6298.51},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14205.55},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12074.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11364.44},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7213.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11069.14},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11007.4},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9356.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7003.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7283.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6763.72,"10th_percentile":6763.72,"90th_percentile":6763.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15115.85,"maximum":34193.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15161.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34193.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29064.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15418.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27355.15},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26644.34},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26495.73},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22520.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15115.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15720.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14492.69,"10th_percentile":14492.69,"90th_percentile":14492.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7468.26,"maximum":16843.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7468.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8477.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16843.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14317.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8235.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13475.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8316.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13124.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13051.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11093.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8074.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5285.22,"maximum":11920.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5285.22},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11920.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10132.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9536.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6258.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9288.35},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9236.54},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7850.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6075.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6318.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47063.54,"maximum":112909.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50062.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49416.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":112909.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95972.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48004.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90327.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48475.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":87980.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50357.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50357.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87489.56},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74364.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47063.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48946.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":94112.51,"10th_percentile":94112.51,"90th_percentile":94112.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2328.6,"10th_percentile":2328.6,"90th_percentile":2328.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":19866.42,"10th_percentile":19866.42,"90th_percentile":19866.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":466778.77,"10th_percentile":466778.77,"90th_percentile":466778.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45177.77,"10th_percentile":45177.77,"90th_percentile":45177.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":127082.82,"10th_percentile":127082.82,"90th_percentile":127082.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":39257.89,"10th_percentile":1293.22,"90th_percentile":45413.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37391.34,"10th_percentile":37391.34,"90th_percentile":57259.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14069.53,"maximum":31732.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14069.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14822.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31732.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26972.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14399.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25385.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14540.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24726.08},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24588.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20899.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14116.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":24570.37,"10th_percentile":3396.61,"90th_percentile":40592.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13294.7,"10th_percentile":11712.84,"90th_percentile":13463.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":9043.46,"10th_percentile":9043.46,"90th_percentile":9043.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":22771.23,"10th_percentile":17099.02,"90th_percentile":26789.68},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":22192.26,"10th_percentile":22192.26,"90th_percentile":22192.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":24488.22,"10th_percentile":15121.22,"90th_percentile":57517.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"1 through 10","median_amount":13558.0,"10th_percentile":13558.0,"90th_percentile":13558.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":41846.44,"10th_percentile":41846.44,"90th_percentile":41846.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"1 through 10","median_amount":30316.65,"10th_percentile":30316.65,"90th_percentile":30316.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"76","median_amount":13447.71,"10th_percentile":1340.0,"90th_percentile":13592.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":12289.56,"10th_percentile":12125.96,"90th_percentile":14115.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7411.76,"maximum":16716.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7411.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8423.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16716.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14208.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8182.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13373.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8263.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13025.59},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12952.93},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11009.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8022.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8343.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"1 through 10","median_amount":12346.11,"10th_percentile":12346.11,"90th_percentile":12346.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":13916.42,"10th_percentile":10099.97,"90th_percentile":13916.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7407.57,"10th_percentile":7407.57,"90th_percentile":7407.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":12359.12,"10th_percentile":12359.12,"90th_percentile":30677.54},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4078.76,"10th_percentile":4078.76,"90th_percentile":4078.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7500.88,"10th_percentile":1736.96,"90th_percentile":7759.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5968.47,"10th_percentile":5956.1,"90th_percentile":7259.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26862.36,"maximum":63135.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27993.47},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28205.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":63135.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53665.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27399.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50508.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49196.31},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28742.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28742.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48921.9},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41582.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27936.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6954.73,"maximum":15685.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6954.73},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15685.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13332.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7756.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12548.45},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7832.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12222.39},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12154.21},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10330.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7603.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7908.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":4108.05,"10th_percentile":4108.05,"90th_percentile":4108.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6876.97,"10th_percentile":6876.97,"90th_percentile":6876.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6814.94,"maximum":15370.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6814.94},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7849.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15370.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13064.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7625.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12296.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11976.72},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7999.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7999.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11909.91},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10123.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7777.53,"maximum":17541.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7777.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8775.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17541.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14910.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8524.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14033.04},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13668.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13592.16},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11553.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8357.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14241.91,"maximum":32120.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14241.91},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14988.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32120.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27302.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25696.75},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14702.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25029.03},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15273.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15273.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24889.43},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21155.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14274.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14845.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11653.26,"maximum":26282.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11653.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26282.56},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22340.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21026.04},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12262.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20479.69},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20365.46},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17310.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11904.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12381.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11489.02,"10th_percentile":11489.02,"90th_percentile":11489.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10117.02,"maximum":22817.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10117.02},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11023.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22817.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19395.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10708.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18254.19},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10813.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17779.87},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11233.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11233.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17680.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15028.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10498.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9836.2,"10th_percentile":9836.2,"90th_percentile":9836.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14997.17,"maximum":33901.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15031.4},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15747.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33901.54},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28816.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15297.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27121.22},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15447.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26416.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16046.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26269.15},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22328.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14997.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15597.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7756.53,"maximum":17493.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7756.53},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17493.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14869.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13995.14},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13631.49},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13555.45},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11521.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8337.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8671.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4468.21,"maximum":10077.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4468.21},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5594.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10077.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8565.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5434.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8062.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5487.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7852.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5700.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5700.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7808.72},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6637.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5540.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":7762.87,"10th_percentile":7762.87,"90th_percentile":7762.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4910.53,"10th_percentile":4910.53,"90th_percentile":4910.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10253.19,"maximum":23124.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10253.19},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23124.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19656.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10835.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18499.88},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10942.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18019.17},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17918.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15230.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11048.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12639.76,"maximum":28507.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12639.76},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13448.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28507.48},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24231.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13064.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22805.98},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13192.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22213.38},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13704.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13704.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22089.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18775.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12807.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13320.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3336.9,"10th_percentile":3336.9,"90th_percentile":3336.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":23345.61,"10th_percentile":23345.61,"90th_percentile":23345.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12308.16,"10th_percentile":8188.24,"90th_percentile":12333.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6394.12,"maximum":14421.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6394.12},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14421.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12258.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7232.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11536.94},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11237.16},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7587.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7587.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11174.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9498.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7090.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":11561.21,"10th_percentile":11561.21,"90th_percentile":87816.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":466.96,"10th_percentile":466.96,"90th_percentile":466.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6350.33,"10th_percentile":6350.33,"90th_percentile":6350.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29061.56,"maximum":68554.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30395.97},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30514.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":68554.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58271.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29642.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54843.6},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29933.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53418.52},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31095.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31095.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53120.56},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45151.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29061.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30224.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13866.72,"maximum":31274.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13866.72},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14627.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31274.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26583.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14209.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25019.8},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14348.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24369.67},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14906.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14906.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24233.74},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20598.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8471.41,"maximum":19106.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8471.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9441.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19106.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16240.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15285.01},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9262.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14887.84},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9621.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9621.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14804.8},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12583.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8992.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25590.71,"maximum":60002.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26604.26},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26870.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":60002.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51002.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26102.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48002.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26358.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46754.89},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27382.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27382.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46494.1},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39518.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25590.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26614.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10744.27,"maximum":24232.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10744.27},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11626.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24232.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20597.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11294.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19385.93},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18882.2},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11847.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18776.88},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15959.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14227.42,"maximum":32088.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14227.42},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14974.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32088.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27275.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14546.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25670.61},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14689.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25003.57},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15259.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15259.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24864.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21133.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14261.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14831.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26692.63,"maximum":62717.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27808.05},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28027.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":62717.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53310.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27226.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50174.2},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27493.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":48870.45},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28561.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28561.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48597.86},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41307.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26692.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27760.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14451.23,"maximum":32593.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14451.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15189.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32593.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27704.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14755.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26074.43},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14900.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25396.9},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15478.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15478.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25255.24},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21466.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14466.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15044.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":34143.58,"10th_percentile":34143.58,"90th_percentile":34143.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":26188.14,"10th_percentile":26188.14,"90th_percentile":26188.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13920.67,"10th_percentile":13920.67,"90th_percentile":13920.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9507.89,"maximum":21443.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9507.89},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10438.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21443.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18227.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10139.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17155.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10239.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16709.36},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16616.16},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14123.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10338.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11839.41,"maximum":26702.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11839.41},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12679.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26702.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22697.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12316.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21361.9},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12437.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20806.82},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12920.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12920.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20690.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17586.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6413.68,"maximum":14465.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6413.68},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7464.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14465.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12295.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7250.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11572.23},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7321.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11271.53},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11208.66},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9527.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7108.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7393.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12179.83,"maximum":27470.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12179.83},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13006.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27470.16},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23349.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12634.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21976.12},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21405.09},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21285.69},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18092.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12386.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14406.88,"10th_percentile":14406.88,"90th_percentile":14406.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4826.01,"maximum":10884.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4826.01},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5938.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10884.5},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9251.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5768.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8707.59},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5825.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8481.33},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8434.03},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7168.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5655.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5881.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":7183.95,"10th_percentile":7183.95,"90th_percentile":7183.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5453.49,"10th_percentile":5158.32,"90th_percentile":5473.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11359.92,"maximum":25620.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11359.92},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12218.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25620.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21777.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11869.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20496.76},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19964.16},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19852.81},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16874.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11636.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12101.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":21564.44,"10th_percentile":21564.44,"90th_percentile":21564.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11282.64,"10th_percentile":11282.64,"90th_percentile":11282.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"1 through 10","median_amount":35701.84,"10th_percentile":35701.84,"90th_percentile":35701.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":19187.25,"10th_percentile":19187.25,"90th_percentile":19187.25},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"1 through 10","median_amount":21337.47,"10th_percentile":21337.47,"90th_percentile":21337.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11405.98,"10th_percentile":11218.4,"90th_percentile":11411.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19.67,"10th_percentile":19.67,"90th_percentile":19.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6207.98,"maximum":14001.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6207.98},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14001.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11901.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7058.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11201.08},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10910.03},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7404.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7404.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10849.17},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9221.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6920.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7197.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"1 through 10","median_amount":13142.53,"10th_percentile":13142.53,"90th_percentile":13142.53},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6554.53,"10th_percentile":6554.53,"90th_percentile":6554.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13260.48,"maximum":29907.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13260.48},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29907.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25421.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13643.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23925.96},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13777.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":23304.25},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14312.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14312.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23174.27},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19697.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13376.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13911.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":44995.96,"10th_percentile":44995.96,"90th_percentile":44995.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"1 through 10","median_amount":1578.2,"10th_percentile":1578.2,"90th_percentile":1578.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12548.73,"10th_percentile":12548.73,"90th_percentile":12548.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7259.66,"maximum":16373.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7259.66},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8277.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16373.3},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13917.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13098.64},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12758.28},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8434.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8434.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12687.11},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10783.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8198.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7327.77,"10th_percentile":7327.77,"90th_percentile":7327.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4986.08,"maximum":11245.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4986.08},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6092.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11245.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9558.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5917.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8996.41},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5975.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8762.64},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8713.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7406.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6034.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12670.9,"maximum":28577.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12670.9},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13478.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28577.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24291.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13093.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22862.17},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13221.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22268.11},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22143.91},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18821.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12836.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13349.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7371.2,"maximum":16624.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7371.2},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8384.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16624.87},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14131.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8144.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13299.89},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8224.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12954.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8544.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8544.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12882.05},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10949.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7985.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7335.46,"10th_percentile":7335.46,"90th_percentile":7335.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":142793.25,"maximum":348776.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154641.67},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149932.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":348776.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":296459.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145649.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":279020.72},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147077.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":271770.51},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152788.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152788.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":270254.63},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":229710.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142793.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148504.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48793.33,"maximum":117171.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51951.87},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51233.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":117171.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99595.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49769.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93737.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50257.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":91301.3},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52208.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52208.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90792.04},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77171.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48793.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50745.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22591.93,"maximum":52614.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23328.25},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23721.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":52614.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44722.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23043.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42091.28},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23269.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40997.56},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24173.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24173.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40768.89},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34652.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22591.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23495.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27056.62,"maximum":63614.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28205.69},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28409.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":63614.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54072.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27597.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50891.66},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27868.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":49569.27},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28950.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28950.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49292.78},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41897.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27056.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28138.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15894.22,"maximum":36111.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16011.38},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16688.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36111.76},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30695.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28889.4},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16371.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28138.73},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17006.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17006.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27981.77},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23783.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15894.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16529.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14895.73,"maximum":33651.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14920.58},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15640.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33651.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28603.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15193.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26921.27},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26221.74},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26075.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22163.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14895.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15491.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25295.01,"maximum":59274.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26281.23},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26559.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":59274.2},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50383.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25800.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47419.34},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26053.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":46187.18},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27065.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27065.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45929.55},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39039.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25295.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26306.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16731.6,"maximum":38174.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16926.17},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17568.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":38174.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32448.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17066.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30539.96},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17233.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":29746.4},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17902.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17902.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29580.48},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25142.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16731.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17400.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":35581.9,"10th_percentile":35581.9,"90th_percentile":35581.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14681.58,"maximum":33123.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14686.63},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15415.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33123.96},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28155.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26499.16},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15122.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25810.59},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15709.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15709.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25666.63},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21816.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14681.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15268.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11216.51,"maximum":25297.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11216.51},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12080.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":25297.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21502.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11735.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20238.0},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11850.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19712.13},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19602.18},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16661.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8306.27,"maximum":18733.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8306.27},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9283.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18733.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15923.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9017.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14987.05},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9106.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14597.62},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9460.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9460.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14516.19},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12338.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8841.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9194.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8685.81,"maximum":19589.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8685.81},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9647.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19589.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16651.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9372.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15671.84},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9464.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15264.62},{"payer_name":"Pruitt Health","plan_name":"I-SNIP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Select Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15179.47},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12902.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9556.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"1 through 10","median_amount":6089.15,"10th_percentile":6089.15,"90th_percentile":6089.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1251.0,"10th_percentile":1251.0,"90th_percentile":3282.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":2044.54,"10th_percentile":1068.79,"90th_percentile":3087.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":2464.91,"10th_percentile":2464.91,"90th_percentile":2464.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":2618.97,"10th_percentile":2618.97,"90th_percentile":2618.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":1660.0,"10th_percentile":1660.0,"90th_percentile":1660.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":175.09,"10th_percentile":175.09,"90th_percentile":536.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"34","median_amount":62.12,"10th_percentile":17.25,"90th_percentile":195.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"55","median_amount":174.15,"10th_percentile":43.2,"90th_percentile":483.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":114.78,"10th_percentile":114.78,"90th_percentile":114.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":102.99,"10th_percentile":102.99,"90th_percentile":102.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"25","median_amount":223.04,"10th_percentile":118.98,"90th_percentile":742.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"54","median_amount":81.79,"10th_percentile":19.24,"90th_percentile":342.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":121.61,"10th_percentile":114.79,"90th_percentile":194.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"14","median_amount":197.27,"10th_percentile":155.24,"90th_percentile":487.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":46.38,"10th_percentile":46.38,"90th_percentile":46.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":67.13,"10th_percentile":67.13,"90th_percentile":67.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"17","median_amount":605.0,"10th_percentile":229.23,"90th_percentile":875.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":100.03,"10th_percentile":100.03,"90th_percentile":100.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":738.0,"10th_percentile":738.0,"90th_percentile":875.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":292.01,"10th_percentile":292.01,"90th_percentile":292.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":612.75,"10th_percentile":612.75,"90th_percentile":612.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":306.13,"10th_percentile":299.76,"90th_percentile":464.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":79.62,"10th_percentile":74.27,"90th_percentile":80.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":83.22,"10th_percentile":83.22,"90th_percentile":83.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"21","median_amount":513.35,"10th_percentile":460.75,"90th_percentile":1333.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"51","median_amount":158.65,"10th_percentile":157.02,"90th_percentile":355.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"120","median_amount":958.0,"10th_percentile":356.92,"90th_percentile":1479.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":143.24,"10th_percentile":141.04,"90th_percentile":143.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":180.66,"10th_percentile":180.66,"90th_percentile":1188.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"50","median_amount":703.99,"10th_percentile":359.96,"90th_percentile":1479.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"62","median_amount":292.01,"10th_percentile":292.01,"90th_percentile":356.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":147.48,"10th_percentile":147.48,"90th_percentile":147.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"17","median_amount":1223.25,"10th_percentile":958.0,"90th_percentile":1818.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":955.25,"10th_percentile":955.25,"90th_percentile":1834.91},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":146.06,"10th_percentile":146.06,"90th_percentile":366.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MultiPlan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":760.0,"10th_percentile":760.0,"90th_percentile":760.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"24","median_amount":481.24,"10th_percentile":362.95,"90th_percentile":950.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":477.24,"10th_percentile":477.24,"90th_percentile":477.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"89","median_amount":144.66,"10th_percentile":142.46,"90th_percentile":145.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":149.68,"10th_percentile":149.68,"90th_percentile":149.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"63","median_amount":1133.94,"10th_percentile":473.33,"90th_percentile":1918.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"181","median_amount":354.15,"10th_percentile":249.04,"90th_percentile":578.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":320.03,"10th_percentile":320.03,"90th_percentile":320.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"565","median_amount":1479.75,"10th_percentile":577.26,"90th_percentile":1553.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"61","median_amount":249.11,"10th_percentile":246.61,"90th_percentile":477.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":1193.95,"10th_percentile":321.87,"90th_percentile":4938.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"171","median_amount":1132.39,"10th_percentile":585.69,"90th_percentile":1516.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"184","median_amount":292.01,"10th_percentile":292.01,"90th_percentile":863.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":256.21,"10th_percentile":256.21,"90th_percentile":353.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"67","median_amount":1818.0,"10th_percentile":711.58,"90th_percentile":1887.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":1723.0,"10th_percentile":503.06,"90th_percentile":1847.07},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":423.99,"10th_percentile":246.07,"90th_percentile":761.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"85","median_amount":1210.53,"10th_percentile":603.08,"90th_percentile":2440.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"13","median_amount":1113.86,"10th_percentile":804.83,"90th_percentile":1742.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"481","median_amount":251.58,"10th_percentile":249.08,"90th_percentile":480.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"108","median_amount":261.71,"10th_percentile":261.71,"90th_percentile":465.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"80","median_amount":2208.78,"10th_percentile":559.33,"90th_percentile":4202.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"185","median_amount":570.41,"10th_percentile":381.37,"90th_percentile":1385.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"732","median_amount":1487.46,"10th_percentile":1088.99,"90th_percentile":2046.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"112","median_amount":646.32,"10th_percentile":327.23,"90th_percentile":990.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":483.74,"10th_percentile":350.59,"90th_percentile":1183.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"232","median_amount":1488.89,"10th_percentile":1018.63,"90th_percentile":2248.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"165","median_amount":292.01,"10th_percentile":292.01,"90th_percentile":933.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":488.18,"10th_percentile":392.83,"90th_percentile":1266.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"101","median_amount":1802.04,"10th_percentile":1723.0,"90th_percentile":1866.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"19","median_amount":1818.0,"10th_percentile":1576.74,"90th_percentile":2689.46},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":650.87,"10th_percentile":125.01,"90th_percentile":1066.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"104","median_amount":2424.43,"10th_percentile":696.16,"90th_percentile":4493.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"17","median_amount":2053.86,"10th_percentile":1278.98,"90th_percentile":4604.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"686","median_amount":616.29,"10th_percentile":383.05,"90th_percentile":1017.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":56.14,"10th_percentile":56.14,"90th_percentile":56.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"144","median_amount":630.94,"10th_percentile":386.05,"90th_percentile":1026.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"60","median_amount":2448.31,"10th_percentile":870.99,"90th_percentile":4794.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"96","median_amount":645.52,"10th_percentile":510.18,"90th_percentile":1481.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3582.0,"10th_percentile":3582.0,"90th_percentile":3582.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"522","median_amount":1515.8,"10th_percentile":1301.17,"90th_percentile":2493.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"128","median_amount":813.12,"10th_percentile":501.97,"90th_percentile":2248.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"12","median_amount":1088.28,"10th_percentile":696.49,"90th_percentile":1213.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"186","median_amount":1594.51,"10th_percentile":1272.68,"90th_percentile":2968.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"73","median_amount":292.01,"10th_percentile":292.01,"90th_percentile":2266.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":787.17,"10th_percentile":639.25,"90th_percentile":978.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"83","median_amount":1818.0,"10th_percentile":1723.0,"90th_percentile":2766.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"17","median_amount":1818.0,"10th_percentile":1723.0,"90th_percentile":2194.05},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":912.55,"10th_percentile":630.75,"90th_percentile":1546.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"101","median_amount":2367.04,"10th_percentile":750.15,"90th_percentile":4135.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"20","median_amount":2364.11,"10th_percentile":792.47,"90th_percentile":3505.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"616","median_amount":828.67,"10th_percentile":560.12,"90th_percentile":1438.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"181","median_amount":861.84,"10th_percentile":140.0,"90th_percentile":1411.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":373.18,"10th_percentile":373.18,"90th_percentile":373.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":2015.9,"10th_percentile":609.48,"90th_percentile":2157.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1713.52,"10th_percentile":1713.52,"90th_percentile":3865.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":292.01,"10th_percentile":292.01,"90th_percentile":292.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":3801.68,"10th_percentile":3801.68,"90th_percentile":3801.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":1105.37,"10th_percentile":1105.37,"90th_percentile":1105.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":358.5,"10th_percentile":179.25,"90th_percentile":649.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1414.6,"10th_percentile":1013.78,"90th_percentile":2015.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":487.27,"10th_percentile":487.27,"90th_percentile":774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":292.01,"10th_percentile":292.01,"90th_percentile":292.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.09,"10th_percentile":197.98,"90th_percentile":936.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":75.52,"10th_percentile":75.52,"90th_percentile":75.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":700.17,"10th_percentile":700.17,"90th_percentile":700.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":6925.13,"10th_percentile":6925.13,"90th_percentile":6925.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":833.65,"10th_percentile":833.65,"90th_percentile":833.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3916.5,"10th_percentile":2453.7,"90th_percentile":7307.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1635.8,"10th_percentile":1635.8,"90th_percentile":1635.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":226.94,"10th_percentile":226.94,"90th_percentile":226.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":11815.7,"10th_percentile":11815.7,"90th_percentile":11815.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1645.44,"10th_percentile":608.91,"90th_percentile":2647.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2286.11,"10th_percentile":2286.11,"90th_percentile":2286.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":4112.0,"10th_percentile":4112.0,"90th_percentile":4112.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":5310.32,"10th_percentile":5310.32,"90th_percentile":5310.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":7203.5,"10th_percentile":7203.5,"90th_percentile":7203.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1363.58,"10th_percentile":800.06,"90th_percentile":1811.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"18","median_amount":2015.9,"10th_percentile":799.28,"90th_percentile":2116.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":632.53,"10th_percentile":632.53,"90th_percentile":632.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1414.47,"10th_percentile":1052.79,"90th_percentile":1713.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":600.85,"10th_percentile":600.85,"90th_percentile":600.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":645.43,"10th_percentile":645.43,"90th_percentile":645.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":2643.0,"10th_percentile":2643.0,"90th_percentile":2643.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":1425.2,"10th_percentile":1425.2,"90th_percentile":1425.2},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":638.4,"10th_percentile":634.9,"90th_percentile":639.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":815.72,"10th_percentile":815.72,"90th_percentile":815.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2037.3,"10th_percentile":1674.66,"90th_percentile":4338.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":1384.9,"10th_percentile":1384.9,"90th_percentile":1384.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"70","median_amount":2586.67,"10th_percentile":1261.53,"90th_percentile":4199.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1448.92,"10th_percentile":1183.32,"90th_percentile":1518.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":282.87,"10th_percentile":282.87,"90th_percentile":282.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"20","median_amount":2296.91,"10th_percentile":1261.53,"90th_percentile":3484.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":2627.45,"10th_percentile":2627.45,"90th_percentile":2627.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1562.79,"10th_percentile":1562.79,"90th_percentile":1562.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":3410.0,"10th_percentile":2012.57,"90th_percentile":8768.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":2708.55,"10th_percentile":2708.55,"90th_percentile":2708.55},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":1440.01,"10th_percentile":1440.01,"90th_percentile":1440.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"13","median_amount":1614.86,"10th_percentile":587.08,"90th_percentile":4243.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":1532.05,"10th_percentile":1532.05,"90th_percentile":1532.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":1459.35,"10th_percentile":228.65,"90th_percentile":1532.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1609.65,"10th_percentile":1531.37,"90th_percentile":1609.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":7583.49,"10th_percentile":7583.49,"90th_percentile":7583.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"15","median_amount":4932.37,"10th_percentile":3377.98,"90th_percentile":12937.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2559.41,"10th_percentile":2550.91,"90th_percentile":2559.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":5931.93,"10th_percentile":5931.93,"90th_percentile":5931.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":3548.88,"10th_percentile":3548.88,"90th_percentile":3548.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":3268.25,"10th_percentile":3268.25,"90th_percentile":3268.25},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":4603.0,"10th_percentile":4603.0,"90th_percentile":4603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2576.4,"10th_percentile":725.81,"90th_percentile":2584.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2705.07,"10th_percentile":2705.07,"90th_percentile":2705.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":4112.0,"10th_percentile":4112.0,"90th_percentile":4112.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":2546.85,"10th_percentile":2546.85,"90th_percentile":2546.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"25","median_amount":3372.42,"10th_percentile":1678.62,"90th_percentile":8452.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5882.93,"10th_percentile":5810.07,"90th_percentile":5883.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"12","median_amount":5053.72,"10th_percentile":4088.06,"90th_percentile":7362.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":3352.65,"10th_percentile":3352.65,"90th_percentile":3352.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":3762.45,"10th_percentile":3762.45,"90th_percentile":3884.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":5282.43,"10th_percentile":5282.43,"90th_percentile":5282.43},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":4603.0,"10th_percentile":4603.0,"90th_percentile":4603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":5350.73,"10th_percentile":5350.73,"90th_percentile":5350.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":5813.42,"10th_percentile":3444.56,"90th_percentile":5948.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3697.53,"10th_percentile":3697.53,"90th_percentile":6163.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":8877.23,"10th_percentile":5709.68,"90th_percentile":22156.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5810.07,"10th_percentile":5810.07,"90th_percentile":5831.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":6344.52,"10th_percentile":6344.52,"90th_percentile":6344.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":6691.37,"10th_percentile":6691.37,"90th_percentile":6691.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5982.41,"10th_percentile":5982.41,"90th_percentile":5982.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":7738.05,"10th_percentile":7738.05,"90th_percentile":7738.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":10314.0,"10th_percentile":10314.0,"90th_percentile":10314.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5889.96,"10th_percentile":5868.16,"90th_percentile":5889.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":8452.1,"10th_percentile":8452.1,"90th_percentile":8452.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":9817.12,"10th_percentile":9817.12,"90th_percentile":9817.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":330.0,"10th_percentile":330.0,"90th_percentile":330.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":18590.11,"10th_percentile":18590.11,"90th_percentile":18590.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":22313.51,"10th_percentile":21478.67,"90th_percentile":26733.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":21818.76,"10th_percentile":21818.76,"90th_percentile":21818.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":23996.15,"10th_percentile":23996.15,"90th_percentile":23996.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":9604.25,"10th_percentile":9604.25,"90th_percentile":9604.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15656.95,"10th_percentile":15656.95,"90th_percentile":15665.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16444.08,"10th_percentile":16444.08,"90th_percentile":16444.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":289.06,"10th_percentile":289.06,"90th_percentile":289.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":228.7,"10th_percentile":228.7,"90th_percentile":228.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":6433.0,"10th_percentile":6433.0,"90th_percentile":6433.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"25","median_amount":5231.11,"10th_percentile":1362.91,"90th_percentile":7187.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1425.36,"10th_percentile":1116.66,"90th_percentile":1432.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":4162.51,"10th_percentile":4162.51,"90th_percentile":4162.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":4479.41,"10th_percentile":4254.04,"90th_percentile":5241.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":10239.17,"10th_percentile":10239.17,"90th_percentile":10239.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":4621.83,"10th_percentile":4621.83,"90th_percentile":11017.89},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":5541.0,"10th_percentile":5541.0,"90th_percentile":5541.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":8787.75,"10th_percentile":8787.75,"90th_percentile":8787.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":1445.43,"10th_percentile":1390.21,"90th_percentile":1447.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1512.63,"10th_percentile":1512.63,"90th_percentile":1512.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":4338.0,"10th_percentile":4338.0,"90th_percentile":4338.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"27","median_amount":5310.76,"10th_percentile":2795.68,"90th_percentile":15703.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2897.23,"10th_percentile":2891.63,"90th_percentile":2982.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":3685.88,"10th_percentile":3685.88,"90th_percentile":3801.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":8949.09,"10th_percentile":7603.3,"90th_percentile":17099.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":3797.09,"10th_percentile":3797.09,"90th_percentile":3797.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":5223.72,"10th_percentile":5223.72,"90th_percentile":5223.72},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":9570.6,"10th_percentile":9570.6,"90th_percentile":9570.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":5882.0,"10th_percentile":5882.0,"90th_percentile":5882.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2928.33,"10th_percentile":2918.63,"90th_percentile":3022.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3066.65,"10th_percentile":3066.65,"90th_percentile":3066.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":450.0,"10th_percentile":450.0,"90th_percentile":7317.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":4880.59,"10th_percentile":4880.59,"90th_percentile":4880.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"32","median_amount":9261.85,"10th_percentile":5023.0,"90th_percentile":17098.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6364.28,"10th_percentile":6362.38,"90th_percentile":6370.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":4555.92,"10th_percentile":4555.92,"90th_percentile":4555.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"12","median_amount":13128.18,"10th_percentile":8775.16,"90th_percentile":20304.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":8903.61,"10th_percentile":4422.88,"90th_percentile":11477.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":9636.76,"10th_percentile":9636.76,"90th_percentile":9636.76},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"19","median_amount":12954.35,"10th_percentile":2553.6,"90th_percentile":31892.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":6432.6,"10th_percentile":6264.96,"90th_percentile":6451.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6751.91,"10th_percentile":6751.91,"90th_percentile":6848.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"30","median_amount":18774.2,"10th_percentile":10218.32,"90th_percentile":21789.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":11645.98,"10th_percentile":11550.33,"90th_percentile":11649.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":14851.65,"10th_percentile":14851.65,"90th_percentile":14851.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":16995.83,"10th_percentile":7015.75,"90th_percentile":22919.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":20000.31,"10th_percentile":19700.08,"90th_percentile":24373.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":19455.2,"10th_percentile":19455.2,"90th_percentile":36555.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":11766.75,"10th_percentile":11425.2,"90th_percentile":11807.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":22499.52,"10th_percentile":19.38,"90th_percentile":32601.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16469.45,"10th_percentile":325.0,"90th_percentile":16562.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":2782.55,"10th_percentile":1100.13,"90th_percentile":21557.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16659.7,"10th_percentile":16659.7,"90th_percentile":16659.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":24642.43,"10th_percentile":24642.43,"90th_percentile":24642.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16714.77,"10th_percentile":16667.52,"90th_percentile":16776.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17555.03,"10th_percentile":17555.03,"90th_percentile":17555.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 7 Musculoskeletal Procedures","code_information":[{"code":"5117","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":19405.66,"10th_percentile":19405.66,"90th_percentile":19405.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3636.06,"10th_percentile":3245.11,"90th_percentile":4093.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":1762.0,"10th_percentile":1762.0,"90th_percentile":1762.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1557.92,"10th_percentile":1557.92,"90th_percentile":1557.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3568.35,"10th_percentile":3396.22,"90th_percentile":10598.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3285.59,"10th_percentile":3285.59,"90th_percentile":3285.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":11466.23,"10th_percentile":11466.23,"90th_percentile":11466.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3329.93,"10th_percentile":3325.03,"90th_percentile":3329.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":22358.53,"10th_percentile":2152.1,"90th_percentile":24617.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.0,"10th_percentile":95.0,"90th_percentile":95.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":22516.06,"10th_percentile":22516.06,"90th_percentile":22516.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":2388.78,"10th_percentile":2388.78,"90th_percentile":2388.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":8016.78,"10th_percentile":8016.78,"90th_percentile":10710.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6234.37,"10th_percentile":6234.37,"90th_percentile":6234.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6542.79,"10th_percentile":6542.79,"90th_percentile":6542.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"22","median_amount":1364.52,"10th_percentile":1245.98,"90th_percentile":4112.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"12","median_amount":2978.16,"10th_percentile":2466.65,"90th_percentile":3880.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":3407.65,"10th_percentile":3407.65,"90th_percentile":3407.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"14","median_amount":1370.61,"10th_percentile":1157.48,"90th_percentile":1466.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":5507.2,"10th_percentile":5507.2,"90th_percentile":5507.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":5754.0,"10th_percentile":5754.0,"90th_percentile":5754.0},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1337.85,"10th_percentile":1337.85,"90th_percentile":1337.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":4160.97,"10th_percentile":4160.97,"90th_percentile":4160.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"13","median_amount":2484.61,"10th_percentile":1661.02,"90th_percentile":3196.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"31","median_amount":5810.64,"10th_percentile":2700.25,"90th_percentile":8468.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2894.25,"10th_percentile":2890.25,"90th_percentile":2900.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":3720.19,"10th_percentile":3720.19,"90th_percentile":3720.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":2033.06,"10th_percentile":1922.61,"90th_percentile":2884.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2987.15,"10th_percentile":2987.15,"90th_percentile":2987.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":5400.19,"10th_percentile":5400.19,"90th_percentile":5400.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":7769.5,"10th_percentile":7769.5,"90th_percentile":7769.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2929.03,"10th_percentile":2923.84,"90th_percentile":4603.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3065.19,"10th_percentile":3065.19,"90th_percentile":3065.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":3701.2,"10th_percentile":2829.8,"90th_percentile":4525.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"16","median_amount":5751.88,"10th_percentile":4047.12,"90th_percentile":12195.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5290.13,"10th_percentile":5290.13,"90th_percentile":5290.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":9749.12,"10th_percentile":9749.12,"90th_percentile":11215.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":3674.12,"10th_percentile":2424.48,"90th_percentile":4408.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":2737.73,"10th_percentile":2737.73,"90th_percentile":2737.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":8874.5,"10th_percentile":8874.5,"90th_percentile":8874.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":5327.92,"10th_percentile":5321.32,"90th_percentile":5329.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5591.2,"10th_percentile":5591.2,"90th_percentile":5591.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1698.11,"10th_percentile":1698.11,"90th_percentile":1698.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":2643.0,"10th_percentile":2643.0,"90th_percentile":2643.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":562.85,"10th_percentile":562.85,"90th_percentile":562.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3739.52,"10th_percentile":3739.52,"90th_percentile":3739.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1389.43,"10th_percentile":1389.43,"90th_percentile":1389.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1403.02,"10th_percentile":1399.58,"90th_percentile":1404.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1468.24,"10th_percentile":1468.24,"90th_percentile":1468.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":4657.2,"10th_percentile":4657.2,"90th_percentile":4657.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"13","median_amount":3900.57,"10th_percentile":1967.38,"90th_percentile":7740.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2814.68,"10th_percentile":2808.24,"90th_percentile":2814.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":3363.2,"10th_percentile":3363.2,"90th_percentile":3363.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":4311.07,"10th_percentile":4311.07,"90th_percentile":4311.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":8094.99,"10th_percentile":8094.99,"90th_percentile":8094.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":2838.97,"10th_percentile":2831.27,"90th_percentile":2855.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2974.87,"10th_percentile":2974.87,"90th_percentile":2974.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":5646.81,"10th_percentile":5646.81,"90th_percentile":5646.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5045.6,"10th_percentile":4882.25,"90th_percentile":7464.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5109.21,"10th_percentile":5109.21,"90th_percentile":5109.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":4059.41,"10th_percentile":4059.41,"90th_percentile":4059.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"55","median_amount":4833.35,"10th_percentile":4352.42,"90th_percentile":5184.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":2865.61,"10th_percentile":584.61,"90th_percentile":2876.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":3866.67,"10th_percentile":3866.67,"90th_percentile":3866.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"16","median_amount":4663.26,"10th_percentile":4364.65,"90th_percentile":5711.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":6233.46,"10th_percentile":5937.01,"90th_percentile":6372.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":6713.02,"10th_percentile":6713.02,"90th_percentile":6713.02},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":2930.9,"10th_percentile":2930.9,"90th_percentile":2930.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":5994.0,"10th_percentile":5670.52,"90th_percentile":8260.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"80","median_amount":2900.26,"10th_percentile":2893.26,"90th_percentile":2912.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":3039.99,"10th_percentile":3039.99,"90th_percentile":3053.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":33.35,"10th_percentile":33.35,"90th_percentile":33.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5077.91,"10th_percentile":5077.91,"90th_percentile":5077.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5128.7,"10th_percentile":5128.7,"90th_percentile":5149.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":18839.86,"10th_percentile":10107.78,"90th_percentile":34258.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10107.78,"10th_percentile":10100.18,"90th_percentile":10141.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":9895.68,"10th_percentile":9895.68,"90th_percentile":33963.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":12156.67,"10th_percentile":11630.48,"90th_percentile":25208.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":10318.42,"10th_percentile":10318.42,"90th_percentile":10318.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":12891.46,"10th_percentile":12891.46,"90th_percentile":12891.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":350.0,"10th_percentile":350.0,"90th_percentile":350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":10207.89,"10th_percentile":10201.19,"90th_percentile":10242.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10718.56,"10th_percentile":10718.56,"90th_percentile":10718.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":23075.42,"10th_percentile":23075.42,"90th_percentile":23075.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":13832.81,"10th_percentile":13832.81,"90th_percentile":13832.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":10620.13,"10th_percentile":10620.13,"90th_percentile":10620.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16181.62,"10th_percentile":16160.52,"90th_percentile":16187.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16971.83,"10th_percentile":16971.83,"90th_percentile":16971.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6785.73,"10th_percentile":6785.73,"90th_percentile":6785.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6827.63,"10th_percentile":6827.63,"90th_percentile":6827.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":20490.37,"10th_percentile":20490.37,"90th_percentile":20490.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":12918.39,"10th_percentile":73.63,"90th_percentile":14559.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21914.83,"10th_percentile":21914.83,"90th_percentile":21914.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":8769.56,"10th_percentile":8769.56,"90th_percentile":8769.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":5100.0,"10th_percentile":5100.0,"90th_percentile":5100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":28758.6,"10th_percentile":28758.6,"90th_percentile":28758.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22101.05,"10th_percentile":22101.05,"90th_percentile":22101.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pacemaker and Similar Procedures","code_information":[{"code":"5221","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3280.67,"10th_percentile":3280.67,"90th_percentile":3280.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":5815.82,"10th_percentile":5815.82,"90th_percentile":5815.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7451.2,"10th_percentile":7451.2,"90th_percentile":7451.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":7113.05,"10th_percentile":6901.75,"90th_percentile":12700.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16986.23,"10th_percentile":9358.72,"90th_percentile":17008.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":15054.62,"10th_percentile":15054.62,"90th_percentile":15054.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":9420.58,"10th_percentile":9367.31,"90th_percentile":17162.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9905.27,"10th_percentile":9905.26,"90th_percentile":18025.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":16546.0,"10th_percentile":16546.0,"90th_percentile":16546.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10329.36,"10th_percentile":10329.36,"90th_percentile":17156.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20272.63,"10th_percentile":20272.63,"90th_percentile":20272.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":27960.55,"10th_percentile":16994.81,"90th_percentile":55296.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28570.49,"10th_percentile":28570.49,"90th_percentile":28621.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":22623.7,"10th_percentile":22623.7,"90th_percentile":22623.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":27780.65,"10th_percentile":27780.65,"90th_percentile":27780.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":28847.07,"10th_percentile":28840.37,"90th_percentile":28905.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30303.06,"10th_percentile":30303.06,"90th_percentile":30303.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":993.39,"10th_percentile":993.39,"90th_percentile":993.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3570.37,"10th_percentile":2153.47,"90th_percentile":7462.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1340.08,"10th_percentile":1340.08,"90th_percentile":1340.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1716.06,"10th_percentile":1716.06,"90th_percentile":1716.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":4436.68,"10th_percentile":4436.68,"90th_percentile":4436.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1194.66,"10th_percentile":983.14,"90th_percentile":2205.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"11","median_amount":4122.04,"10th_percentile":4112.0,"90th_percentile":5995.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":762.74,"10th_percentile":756.4,"90th_percentile":3997.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"98","median_amount":1960.05,"10th_percentile":1345.62,"90th_percentile":2056.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":836.91,"10th_percentile":835.01,"90th_percentile":1242.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":1081.51,"10th_percentile":1081.51,"90th_percentile":1081.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"18","median_amount":1726.36,"10th_percentile":1146.57,"90th_percentile":2034.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":967.69,"10th_percentile":967.69,"90th_percentile":971.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"19","median_amount":3218.28,"10th_percentile":868.56,"90th_percentile":3393.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":3202.51,"10th_percentile":3202.51,"90th_percentile":3202.51},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":855.18,"10th_percentile":855.18,"90th_percentile":855.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"20","median_amount":4243.0,"10th_percentile":2141.97,"90th_percentile":5924.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":3997.0,"10th_percentile":3997.0,"90th_percentile":3997.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"100","median_amount":846.77,"10th_percentile":843.36,"90th_percentile":1260.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":886.13,"10th_percentile":886.13,"90th_percentile":1316.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":4338.0,"10th_percentile":4338.0,"90th_percentile":4338.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":626.35,"10th_percentile":626.35,"90th_percentile":626.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"19","median_amount":1811.92,"10th_percentile":1358.44,"90th_percentile":3622.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1691.4,"10th_percentile":1689.5,"90th_percentile":1697.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1433.5,"10th_percentile":1433.5,"90th_percentile":1496.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":840.64,"10th_percentile":840.64,"90th_percentile":840.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1747.29,"10th_percentile":1747.29,"90th_percentile":1747.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":3926.9,"10th_percentile":3377.13,"90th_percentile":7199.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":6775.16,"10th_percentile":6775.16,"90th_percentile":6775.16},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":5995.5,"10th_percentile":5995.5,"90th_percentile":6421.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":1711.77,"10th_percentile":1696.4,"90th_percentile":1713.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1792.94,"10th_percentile":1792.94,"90th_percentile":1792.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":5085.57,"10th_percentile":5085.57,"90th_percentile":5085.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3388.41,"10th_percentile":3388.41,"90th_percentile":3388.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3436.13,"10th_percentile":3436.13,"90th_percentile":3436.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"23","median_amount":4112.0,"10th_percentile":3974.28,"90th_percentile":4338.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":693.53,"10th_percentile":690.17,"90th_percentile":969.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"271","median_amount":1373.98,"10th_percentile":1330.52,"90th_percentile":2046.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":811.99,"10th_percentile":811.99,"90th_percentile":811.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":1035.7,"10th_percentile":1035.7,"90th_percentile":1090.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"68","median_amount":1510.19,"10th_percentile":1143.78,"90th_percentile":1977.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":746.86,"10th_percentile":746.86,"90th_percentile":746.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"31","median_amount":3393.28,"10th_percentile":3178.0,"90th_percentile":3413.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":3218.28,"10th_percentile":3218.28,"90th_percentile":3218.28},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"54","median_amount":3997.0,"10th_percentile":3397.0,"90th_percentile":4199.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":3984.29,"10th_percentile":3957.28,"90th_percentile":4243.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"162","median_amount":820.12,"10th_percentile":820.12,"90th_percentile":821.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":861.7,"10th_percentile":861.7,"90th_percentile":861.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"13","median_amount":4112.0,"10th_percentile":4112.0,"90th_percentile":4338.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":1299.45,"10th_percentile":1299.45,"90th_percentile":1345.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"162","median_amount":1360.73,"10th_percentile":1330.52,"90th_percentile":1520.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":1050.12,"10th_percentile":1050.12,"90th_percentile":1575.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":1339.44,"10th_percentile":1339.44,"90th_percentile":1339.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"31","median_amount":1348.62,"10th_percentile":1133.73,"90th_percentile":1516.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":1075.78,"10th_percentile":1075.78,"90th_percentile":1075.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1092.81,"10th_percentile":1092.81,"90th_percentile":1092.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"28","median_amount":3222.27,"10th_percentile":3198.14,"90th_percentile":4010.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":3218.28,"10th_percentile":3218.28,"90th_percentile":3218.28},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":1075.49,"10th_percentile":1075.49,"90th_percentile":1075.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"22","median_amount":3997.0,"10th_percentile":3997.0,"90th_percentile":5995.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":5574.32,"10th_percentile":5227.39,"90th_percentile":5995.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"136","median_amount":1060.63,"10th_percentile":1060.63,"90th_percentile":1592.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1557.48,"10th_percentile":1114.41,"90th_percentile":1671.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":3934.97,"10th_percentile":3934.97,"90th_percentile":3934.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"19","median_amount":1546.28,"10th_percentile":1345.62,"90th_percentile":8156.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2453.59,"10th_percentile":2453.59,"90th_percentile":2453.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":6366.15,"10th_percentile":1510.2,"90th_percentile":10613.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":6507.92,"10th_percentile":6507.92,"90th_percentile":6507.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":2165.56,"10th_percentile":2165.56,"90th_percentile":2165.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":2466.86,"10th_percentile":2405.43,"90th_percentile":2466.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2591.97,"10th_percentile":2591.97,"90th_percentile":2591.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1360.73,"10th_percentile":1360.73,"90th_percentile":1360.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5355.73,"10th_percentile":5355.73,"90th_percentile":5355.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":3604.19,"10th_percentile":3604.19,"90th_percentile":3604.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":3136.11,"10th_percentile":3136.11,"90th_percentile":3136.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":11267.78,"10th_percentile":6328.89,"90th_percentile":16005.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5042.01,"10th_percentile":5042.01,"90th_percentile":5042.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":9972.98,"10th_percentile":9260.37,"90th_percentile":17366.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":2197.81,"10th_percentile":2197.81,"90th_percentile":2197.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3187.33,"10th_percentile":3102.85,"90th_percentile":5361.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3335.5,"10th_percentile":3335.5,"90th_percentile":3335.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":3408.97,"10th_percentile":3408.97,"90th_percentile":3408.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":5629.51,"10th_percentile":5629.51,"90th_percentile":5629.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5617.85,"10th_percentile":5617.85,"90th_percentile":5617.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":6433.0,"10th_percentile":6098.0,"90th_percentile":24184.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":4603.54,"10th_percentile":1169.64,"90th_percentile":40508.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"111","median_amount":5474.5,"10th_percentile":5168.57,"90th_percentile":14808.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5197.22,"10th_percentile":4936.52,"90th_percentile":9272.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":6627.84,"10th_percentile":6627.84,"90th_percentile":6627.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"14","median_amount":12674.46,"10th_percentile":4482.39,"90th_percentile":15031.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":5153.65,"10th_percentile":3789.29,"90th_percentile":6849.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":8961.51,"10th_percentile":3779.55,"90th_percentile":21902.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":6604.32,"10th_percentile":6604.32,"90th_percentile":6604.32},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":7872.0,"10th_percentile":7416.0,"90th_percentile":18109.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":8510.4,"10th_percentile":8510.4,"90th_percentile":8510.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":5254.89,"10th_percentile":5239.17,"90th_percentile":5269.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5514.36,"10th_percentile":5514.36,"90th_percentile":9840.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":5848.07,"10th_percentile":5848.07,"90th_percentile":5848.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":6849.96,"10th_percentile":6849.96,"90th_percentile":6849.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"60","median_amount":5314.61,"10th_percentile":5235.09,"90th_percentile":20374.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9279.99,"10th_percentile":9279.99,"90th_percentile":9279.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":11829.05,"10th_percentile":11829.05,"90th_percentile":11829.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"20","median_amount":14508.16,"10th_percentile":4472.95,"90th_percentile":21178.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":11340.84,"10th_percentile":11340.84,"90th_percentile":11340.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":8891.96,"10th_percentile":8891.96,"90th_percentile":8891.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":7872.0,"10th_percentile":7416.0,"90th_percentile":13776.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":7872.0,"10th_percentile":7872.0,"90th_percentile":66600.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9367.73,"10th_percentile":9367.73,"90th_percentile":9367.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":363.44,"10th_percentile":363.44,"90th_percentile":363.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":6596.43,"10th_percentile":6596.43,"90th_percentile":6596.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":675.53,"10th_percentile":675.53,"90th_percentile":675.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":605.86,"10th_percentile":605.86,"90th_percentile":605.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":2626.15,"10th_percentile":1882.91,"90th_percentile":7071.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1831.96,"10th_percentile":1831.96,"90th_percentile":1831.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":4628.91,"10th_percentile":4628.91,"90th_percentile":4628.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":2711.27,"10th_percentile":2711.27,"90th_percentile":2711.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1850.16,"10th_percentile":1850.16,"90th_percentile":1850.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"20","median_amount":6514.22,"10th_percentile":3874.29,"90th_percentile":7383.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3077.63,"10th_percentile":3077.63,"90th_percentile":3077.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":14045.62,"10th_percentile":14045.62,"90th_percentile":14045.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":11080.92,"10th_percentile":11080.92,"90th_percentile":11080.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":3632.1,"10th_percentile":3632.1,"90th_percentile":3632.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":17518.54,"10th_percentile":17518.54,"90th_percentile":17518.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":3109.15,"10th_percentile":3102.45,"90th_percentile":3114.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3259.8,"10th_percentile":3259.8,"90th_percentile":3259.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":7826.45,"10th_percentile":7826.45,"90th_percentile":7826.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":2891.56,"10th_percentile":346.79,"90th_percentile":2924.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"33","median_amount":6547.03,"10th_percentile":4783.81,"90th_percentile":6863.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4529.49,"10th_percentile":4527.59,"90th_percentile":4546.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":6567.14,"10th_percentile":5604.3,"90th_percentile":16024.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4682.45,"10th_percentile":4682.45,"90th_percentile":4682.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":8748.38,"10th_percentile":8732.42,"90th_percentile":12543.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":6692.0,"10th_percentile":6692.0,"90th_percentile":6692.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":4579.57,"10th_percentile":4572.87,"90th_percentile":4602.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4804.79,"10th_percentile":4804.79,"90th_percentile":4804.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":7440.0,"10th_percentile":7440.0,"90th_percentile":7440.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":594.77,"10th_percentile":594.77,"90th_percentile":1667.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1324.05,"10th_percentile":1324.05,"90th_percentile":1324.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":7592.0,"10th_percentile":7592.0,"90th_percentile":7592.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":2015.9,"10th_percentile":2015.9,"90th_percentile":2015.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":472.2,"10th_percentile":472.2,"90th_percentile":472.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":2546.42,"10th_percentile":2546.42,"90th_percentile":2546.42},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":6125.02,"10th_percentile":4112.0,"90th_percentile":6912.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":3323.78,"10th_percentile":2679.09,"90th_percentile":4063.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"32","median_amount":5225.69,"10th_percentile":2644.81,"90th_percentile":8147.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2843.33,"10th_percentile":2843.33,"90th_percentile":2843.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":7013.61,"10th_percentile":5228.84,"90th_percentile":9156.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":4104.61,"10th_percentile":2678.71,"90th_percentile":6333.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":6604.19,"10th_percentile":4015.93,"90th_percentile":6839.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":6119.31,"10th_percentile":6119.31,"90th_percentile":6119.31},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":4886.0,"10th_percentile":4886.0,"90th_percentile":4886.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2872.34,"10th_percentile":2869.0,"90th_percentile":2872.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3005.14,"10th_percentile":3005.14,"90th_percentile":3005.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"14","median_amount":7727.78,"10th_percentile":5225.82,"90th_percentile":17928.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":8401.36,"10th_percentile":8401.36,"90th_percentile":8401.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":8925.71,"10th_percentile":4927.57,"90th_percentile":19431.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":19100.8,"10th_percentile":19100.8,"90th_percentile":19100.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":8256.6,"10th_percentile":8256.6,"90th_percentile":8256.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4458.44,"10th_percentile":4450.08,"90th_percentile":4459.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4665.7,"10th_percentile":4665.7,"90th_percentile":4665.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":7389.08,"10th_percentile":7389.08,"90th_percentile":7389.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6594.27,"10th_percentile":6594.27,"90th_percentile":6594.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":6125.02,"10th_percentile":6125.02,"90th_percentile":6125.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":1097.56,"10th_percentile":1097.56,"90th_percentile":1097.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"26","median_amount":3886.28,"10th_percentile":678.45,"90th_percentile":8302.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1741.09,"10th_percentile":1741.09,"90th_percentile":5711.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":7275.03,"10th_percentile":6832.53,"90th_percentile":7275.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":3303.34,"10th_percentile":3298.01,"90th_percentile":6732.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":3965.61,"10th_percentile":3965.61,"90th_percentile":3965.61},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":6904.5,"10th_percentile":6904.5,"90th_percentile":6904.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":8993.25,"10th_percentile":8993.25,"90th_percentile":8993.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":1763.69,"10th_percentile":1756.59,"90th_percentile":5767.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":278.91,"10th_percentile":278.91,"90th_percentile":278.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"16","median_amount":2042.84,"10th_percentile":980.15,"90th_percentile":2073.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":264.8,"10th_percentile":3.2,"90th_percentile":272.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":974.92,"10th_percentile":974.92,"90th_percentile":974.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":416.76,"10th_percentile":416.76,"90th_percentile":416.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":2643.0,"10th_percentile":2643.0,"90th_percentile":2643.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":270.98,"10th_percentile":266.61,"90th_percentile":414.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":3420.0,"10th_percentile":3409.5,"90th_percentile":4089.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"26","median_amount":2017.62,"10th_percentile":629.36,"90th_percentile":2044.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":621.47,"10th_percentile":618.67,"90th_percentile":625.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":11.9,"10th_percentile":11.9,"90th_percentile":11.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1400.06,"10th_percentile":1400.06,"90th_percentile":1400.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":473.79,"10th_percentile":473.79,"90th_percentile":473.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":2665.99,"10th_percentile":2665.99,"90th_percentile":2665.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":35.62,"10th_percentile":35.62,"90th_percentile":35.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":629.83,"10th_percentile":625.46,"90th_percentile":635.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":664.43,"10th_percentile":664.43,"90th_percentile":664.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":3409.5,"10th_percentile":3409.5,"90th_percentile":3409.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":960.67,"10th_percentile":955.98,"90th_percentile":1055.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"43","median_amount":2017.62,"10th_percentile":1249.17,"90th_percentile":3047.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1191.28,"10th_percentile":1189.38,"90th_percentile":1194.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1890.16,"10th_percentile":1232.47,"90th_percentile":2570.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":820.04,"10th_percentile":820.04,"90th_percentile":1230.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":4010.48,"10th_percentile":4010.48,"90th_percentile":4010.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":3757.5,"10th_percentile":3757.5,"90th_percentile":3757.5},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":4432.5,"10th_percentile":2955.0,"90th_percentile":6080.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"79","median_amount":1202.28,"10th_percentile":804.09,"90th_percentile":1209.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1262.2,"10th_percentile":841.46,"90th_percentile":1262.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5910.22,"10th_percentile":5910.22,"90th_percentile":5910.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4.99,"10th_percentile":4.99,"90th_percentile":4.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":32725.24,"10th_percentile":32725.24,"90th_percentile":36538.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":26638.49,"10th_percentile":26638.49,"90th_percentile":26638.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"13","median_amount":275.48,"10th_percentile":272.09,"90th_percentile":673.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"11","median_amount":61.77,"10th_percentile":54.38,"90th_percentile":75.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"200","median_amount":203.66,"10th_percentile":83.33,"90th_percentile":397.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":78.42,"10th_percentile":78.42,"90th_percentile":80.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":100.03,"10th_percentile":100.03,"90th_percentile":162.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"65","median_amount":210.9,"10th_percentile":78.74,"90th_percentile":566.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"13","median_amount":65.16,"10th_percentile":57.43,"90th_percentile":95.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":82.42,"10th_percentile":82.42,"90th_percentile":170.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"22","median_amount":106.41,"10th_percentile":52.92,"90th_percentile":170.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":106.41,"10th_percentile":81.27,"90th_percentile":227.2},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":81.62,"10th_percentile":81.62,"90th_percentile":81.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"23","median_amount":199.53,"10th_percentile":79.31,"90th_percentile":400.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":286.92,"10th_percentile":199.53,"90th_percentile":2046.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"186","median_amount":79.53,"10th_percentile":79.21,"90th_percentile":88.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":83.22,"10th_percentile":83.22,"90th_percentile":83.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"104","median_amount":684.08,"10th_percentile":196.3,"90th_percentile":828.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"21","median_amount":236.25,"10th_percentile":138.35,"90th_percentile":326.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1057","median_amount":592.54,"10th_percentile":192.46,"90th_percentile":628.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"241","median_amount":96.64,"10th_percentile":94.71,"90th_percentile":192.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"16","median_amount":241.29,"10th_percentile":120.8,"90th_percentile":490.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"296","median_amount":521.34,"10th_percentile":192.47,"90th_percentile":940.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"27","median_amount":240.58,"10th_percentile":95.94,"90th_percentile":397.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":198.25,"10th_percentile":97.55,"90th_percentile":1986.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"95","median_amount":576.64,"10th_percentile":140.64,"90th_percentile":726.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"26","median_amount":655.35,"10th_percentile":97.55,"90th_percentile":778.39},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"31","median_amount":187.23,"10th_percentile":96.6,"90th_percentile":196.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"133","median_amount":593.28,"10th_percentile":194.41,"90th_percentile":873.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"20","median_amount":280.2,"10th_percentile":185.35,"90th_percentile":873.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"675","median_amount":97.61,"10th_percentile":95.66,"90th_percentile":194.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"91","median_amount":100.51,"10th_percentile":100.51,"90th_percentile":204.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"14","median_amount":824.0,"10th_percentile":549.0,"90th_percentile":2944.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":393.18,"10th_percentile":378.9,"90th_percentile":575.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"120","median_amount":662.76,"10th_percentile":441.84,"90th_percentile":1043.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":216.17,"10th_percentile":216.17,"90th_percentile":219.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":274.6,"10th_percentile":274.6,"90th_percentile":795.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"33","median_amount":662.76,"10th_percentile":441.84,"90th_percentile":1211.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":387.61,"10th_percentile":387.61,"90th_percentile":387.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":226.27,"10th_percentile":226.27,"90th_percentile":320.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":869.0,"10th_percentile":579.0,"90th_percentile":2376.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":579.0,"10th_percentile":579.0,"90th_percentile":579.0},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":220.59,"10th_percentile":220.59,"90th_percentile":224.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"12","median_amount":582.6,"10th_percentile":582.6,"90th_percentile":1660.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":1660.0,"10th_percentile":582.6,"90th_percentile":1762.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"134","median_amount":218.33,"10th_percentile":217.45,"90th_percentile":314.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":228.47,"10th_percentile":228.47,"90th_percentile":396.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":500.14,"10th_percentile":500.14,"90th_percentile":1843.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"30","median_amount":862.28,"10th_percentile":617.69,"90th_percentile":2162.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":488.33,"10th_percentile":466.95,"90th_percentile":501.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":494.71,"10th_percentile":494.71,"90th_percentile":494.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1663.38,"10th_percentile":495.93,"90th_percentile":3439.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":750.74,"10th_percentile":750.74,"90th_percentile":750.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":502.98,"10th_percentile":502.98,"90th_percentile":502.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":3053.69,"10th_percentile":3053.69,"90th_percentile":3053.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":2973.75,"10th_percentile":2973.75,"90th_percentile":2973.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":495.21,"10th_percentile":493.22,"90th_percentile":499.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":518.23,"10th_percentile":518.23,"90th_percentile":518.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":547.16,"10th_percentile":289.55,"90th_percentile":576.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":102.73,"10th_percentile":102.73,"90th_percentile":344.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"100","median_amount":451.98,"10th_percentile":226.2,"90th_percentile":695.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":161.04,"10th_percentile":158.54,"90th_percentile":389.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":202.23,"10th_percentile":202.23,"90th_percentile":361.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"30","median_amount":509.1,"10th_percentile":384.16,"90th_percentile":2037.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":408.33,"10th_percentile":408.33,"90th_percentile":408.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":248.1,"10th_percentile":248.1,"90th_percentile":248.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":1098.01,"10th_percentile":549.0,"90th_percentile":1743.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":1743.04,"10th_percentile":1743.04,"90th_percentile":1743.04},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":401.78,"10th_percentile":401.78,"90th_percentile":401.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"13","median_amount":460.67,"10th_percentile":455.55,"90th_percentile":911.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":460.67,"10th_percentile":460.67,"90th_percentile":874.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"160","median_amount":163.4,"10th_percentile":160.14,"90th_percentile":394.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":255.62,"10th_percentile":168.25,"90th_percentile":411.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"19","median_amount":549.01,"10th_percentile":547.16,"90th_percentile":2981.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":831.95,"10th_percentile":710.52,"90th_percentile":950.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"236","median_amount":662.76,"10th_percentile":441.84,"90th_percentile":1327.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":319.37,"10th_percentile":299.35,"90th_percentile":708.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":701.67,"10th_percentile":353.47,"90th_percentile":1620.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"52","median_amount":805.23,"10th_percentile":375.56,"90th_percentile":1565.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":668.36,"10th_percentile":292.01,"90th_percentile":716.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":328.95,"10th_percentile":328.95,"90th_percentile":328.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"19","median_amount":824.0,"10th_percentile":549.01,"90th_percentile":1738.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":869.0,"10th_percentile":579.0,"90th_percentile":1792.92},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":330.93,"10th_percentile":330.93,"90th_percentile":330.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"MultiPlan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":321.31,"10th_percentile":321.31,"90th_percentile":321.31},{"payer_name":"MultiPlan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":2730.22,"10th_percentile":2730.22,"90th_percentile":2730.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"22","median_amount":954.63,"10th_percentile":954.63,"90th_percentile":1762.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":959.75,"10th_percentile":954.63,"90th_percentile":959.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"237","median_amount":322.56,"10th_percentile":321.26,"90th_percentile":483.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":337.54,"10th_percentile":337.54,"90th_percentile":767.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1528.91,"10th_percentile":1528.91,"90th_percentile":1528.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1026.75,"10th_percentile":851.66,"90th_percentile":1038.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"39","median_amount":1041.73,"10th_percentile":668.26,"90th_percentile":1167.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":357.88,"10th_percentile":347.64,"90th_percentile":359.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":456.48,"10th_percentile":456.48,"90th_percentile":916.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"13","median_amount":782.81,"10th_percentile":712.06,"90th_percentile":899.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":527.33,"10th_percentile":527.33,"90th_percentile":546.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":920.33,"10th_percentile":920.33,"90th_percentile":920.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":362.92,"10th_percentile":362.92,"90th_percentile":366.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":379.79,"10th_percentile":379.79,"90th_percentile":379.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":788.13,"10th_percentile":788.13,"90th_percentile":788.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":363.95,"10th_percentile":363.95,"90th_percentile":363.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"31","median_amount":1471.47,"10th_percentile":801.06,"90th_percentile":1471.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":479.4,"10th_percentile":479.4,"90th_percentile":479.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":708.93,"10th_percentile":708.92,"90th_percentile":801.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":643.05,"10th_percentile":643.05,"90th_percentile":643.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":734.18,"10th_percentile":706.9,"90th_percentile":734.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":1425.95,"10th_percentile":1425.95,"90th_percentile":1425.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":486.15,"10th_percentile":484.19,"90th_percentile":489.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":508.75,"10th_percentile":508.75,"90th_percentile":508.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":2505.36,"10th_percentile":2387.87,"90th_percentile":3167.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1162.89,"10th_percentile":1162.89,"90th_percentile":1169.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":2256.26,"10th_percentile":1915.73,"90th_percentile":3167.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":3691.69,"10th_percentile":3691.69,"90th_percentile":3691.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1179.06,"10th_percentile":1174.32,"90th_percentile":1973.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3225.07,"10th_percentile":3225.07,"90th_percentile":3225.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"12","median_amount":6364.81,"10th_percentile":3796.61,"90th_percentile":6364.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1304.36,"10th_percentile":1304.36,"90th_percentile":1307.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":4255.82,"10th_percentile":4255.8,"90th_percentile":6364.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":4182.0,"10th_percentile":4182.0,"90th_percentile":4182.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":3607.73,"10th_percentile":3607.73,"90th_percentile":3607.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":150.0,"10th_percentile":150.0,"90th_percentile":150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":1316.66,"10th_percentile":1312.06,"90th_percentile":1317.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1378.59,"10th_percentile":1378.59,"90th_percentile":1378.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1237.39,"10th_percentile":1237.39,"90th_percentile":1237.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":219.71,"10th_percentile":48.74,"90th_percentile":404.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":191.44,"10th_percentile":191.44,"90th_percentile":191.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"57","median_amount":171.65,"10th_percentile":69.24,"90th_percentile":346.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":47.78,"10th_percentile":47.78,"90th_percentile":47.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"18","median_amount":293.74,"10th_percentile":171.64,"90th_percentile":514.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":379.59,"10th_percentile":75.92,"90th_percentile":379.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":88.32,"10th_percentile":88.32,"90th_percentile":99.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":163.64,"10th_percentile":163.64,"90th_percentile":163.64},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":69.24,"10th_percentile":48.07,"90th_percentile":247.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":231.47,"10th_percentile":231.47,"90th_percentile":231.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":48.07,"10th_percentile":47.78,"90th_percentile":48.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.5,"10th_percentile":50.5,"90th_percentile":50.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":692.7,"10th_percentile":692.7,"90th_percentile":692.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":154.15,"10th_percentile":154.15,"90th_percentile":154.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":320.59,"10th_percentile":320.59,"90th_percentile":320.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1691.73,"10th_percentile":1691.73,"90th_percentile":1691.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":321.68,"10th_percentile":321.68,"90th_percentile":321.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":324.89,"10th_percentile":324.89,"90th_percentile":324.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":772.1,"10th_percentile":772.1,"90th_percentile":772.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":869.17,"10th_percentile":869.17,"90th_percentile":869.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":6567.86,"10th_percentile":6567.86,"90th_percentile":6567.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":2246.5,"10th_percentile":2246.5,"90th_percentile":2246.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":2669.2,"10th_percentile":2669.2,"90th_percentile":2669.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":7898.0,"10th_percentile":7898.0,"90th_percentile":7898.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":366.23,"10th_percentile":366.23,"90th_percentile":366.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"13","median_amount":684.68,"10th_percentile":145.23,"90th_percentile":3977.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.96,"10th_percentile":132.96,"90th_percentile":272.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":705.19,"10th_percentile":705.19,"90th_percentile":705.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":659.25,"10th_percentile":659.25,"90th_percentile":659.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":248.03,"10th_percentile":248.03,"90th_percentile":1405.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":1145.33,"10th_percentile":1145.33,"90th_percentile":1145.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":275.08,"10th_percentile":205.02,"90th_percentile":767.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":67.27,"10th_percentile":67.27,"90th_percentile":67.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":806.33,"10th_percentile":806.33,"90th_percentile":806.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":360.67,"10th_percentile":289.72,"90th_percentile":1538.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"31","median_amount":575.1,"10th_percentile":285.64,"90th_percentile":3507.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":266.07,"10th_percentile":266.07,"90th_percentile":266.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"11","median_amount":538.0,"10th_percentile":89.31,"90th_percentile":1609.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":265.24,"10th_percentile":191.76,"90th_percentile":2307.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":897.79,"10th_percentile":897.79,"90th_percentile":897.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":423.61,"10th_percentile":331.99,"90th_percentile":868.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":199.14,"10th_percentile":199.14,"90th_percentile":199.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":12145.56,"10th_percentile":12145.56,"90th_percentile":12145.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"13","median_amount":1076.7,"10th_percentile":1076.7,"90th_percentile":1076.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":382.0,"10th_percentile":382.0,"90th_percentile":382.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"139","median_amount":845.42,"10th_percentile":781.29,"90th_percentile":910.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":139.55,"10th_percentile":139.35,"90th_percentile":142.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":728.16,"10th_percentile":728.16,"90th_percentile":728.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"21","median_amount":781.3,"10th_percentile":718.61,"90th_percentile":910.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":163.52,"10th_percentile":163.52,"90th_percentile":163.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":146.03,"10th_percentile":146.03,"90th_percentile":146.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"15","median_amount":1148.85,"10th_percentile":1067.09,"90th_percentile":1148.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":1067.09,"10th_percentile":1067.09,"90th_percentile":1148.85},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"32","median_amount":1019.45,"10th_percentile":141.64,"90th_percentile":1097.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":141.31,"10th_percentile":141.04,"90th_percentile":142.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":147.88,"10th_percentile":147.88,"90th_percentile":147.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1076.7,"10th_percentile":1076.7,"90th_percentile":1374.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":367.53,"10th_percentile":367.53,"90th_percentile":367.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"57","median_amount":841.16,"10th_percentile":657.4,"90th_percentile":1161.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":277.34,"10th_percentile":277.34,"90th_percentile":494.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":808.19,"10th_percentile":808.19,"90th_percentile":808.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":657.39,"10th_percentile":391.79,"90th_percentile":1320.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":281.26,"10th_percentile":281.26,"90th_percentile":1208.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":1148.85,"10th_percentile":1105.39,"90th_percentile":1857.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":1105.39,"10th_percentile":1105.39,"90th_percentile":1148.85},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":823.67,"10th_percentile":823.67,"90th_percentile":1218.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":1401.13,"10th_percentile":1401.13,"90th_percentile":1401.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":281.02,"10th_percentile":278.47,"90th_percentile":282.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":294.32,"10th_percentile":294.32,"90th_percentile":522.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":482.01,"10th_percentile":482.01,"90th_percentile":482.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"14","median_amount":1299.7,"10th_percentile":1009.15,"90th_percentile":2037.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":472.57,"10th_percentile":472.57,"90th_percentile":472.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1201.11,"10th_percentile":1104.75,"90th_percentile":1381.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1886.29,"10th_percentile":1886.29,"90th_percentile":1886.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":1886.29,"10th_percentile":1886.29,"90th_percentile":1886.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":1954.6,"10th_percentile":1954.6,"90th_percentile":1954.6},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":2012.21,"10th_percentile":1567.25,"90th_percentile":2147.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":1567.25,"10th_percentile":1567.25,"90th_percentile":1802.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":478.29,"10th_percentile":477.29,"90th_percentile":479.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":501.5,"10th_percentile":501.5,"90th_percentile":501.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":4364.03,"10th_percentile":4282.55,"90th_percentile":4699.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":1539.14,"10th_percentile":1539.14,"90th_percentile":3620.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"56","median_amount":3602.97,"10th_percentile":2252.31,"90th_percentile":3898.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":906.11,"10th_percentile":906.11,"90th_percentile":913.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"11","median_amount":3620.3,"10th_percentile":3602.97,"90th_percentile":3671.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":1605.32,"10th_percentile":1538.75,"90th_percentile":1605.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":4656.47,"10th_percentile":4569.53,"90th_percentile":5014.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":751.6,"10th_percentile":751.6,"90th_percentile":751.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":4701.25,"10th_percentile":4448.61,"90th_percentile":4790.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":9509.0,"10th_percentile":9509.0,"90th_percentile":9509.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"64","median_amount":916.18,"10th_percentile":915.18,"90th_percentile":918.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":961.58,"10th_percentile":961.58,"90th_percentile":961.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22.04,"10th_percentile":22.04,"90th_percentile":22.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":51.9,"10th_percentile":51.9,"90th_percentile":51.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":67.07,"10th_percentile":35.24,"90th_percentile":72.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34.96,"10th_percentile":34.96,"90th_percentile":35.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":58.36,"10th_percentile":35.24,"90th_percentile":66.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":145.0,"10th_percentile":145.0,"90th_percentile":217.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":105.93,"10th_percentile":35.46,"90th_percentile":213.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":283.08,"10th_percentile":55.06,"90th_percentile":468.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":46.46,"10th_percentile":40.96,"90th_percentile":92.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"67","median_amount":170.73,"10th_percentile":96.35,"90th_percentile":315.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":53.12,"10th_percentile":52.9,"90th_percentile":53.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"15","median_amount":267.88,"10th_percentile":102.31,"90th_percentile":315.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":72.98,"10th_percentile":45.59,"90th_percentile":436.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.49,"10th_percentile":54.49,"90th_percentile":54.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"13","median_amount":151.96,"10th_percentile":112.46,"90th_percentile":639.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":161.52,"10th_percentile":161.52,"90th_percentile":161.52},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":53.96,"10th_percentile":53.96,"90th_percentile":55.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"16","median_amount":149.47,"10th_percentile":53.12,"90th_percentile":166.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"124","median_amount":53.83,"10th_percentile":53.43,"90th_percentile":54.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":56.14,"10th_percentile":56.14,"90th_percentile":56.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":584.93,"10th_percentile":507.81,"90th_percentile":958.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":145.89,"10th_percentile":77.67,"90th_percentile":661.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"132","median_amount":125.01,"10th_percentile":64.04,"90th_percentile":513.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":114.8,"10th_percentile":114.8,"90th_percentile":115.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":146.43,"10th_percentile":146.43,"90th_percentile":146.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"38","median_amount":319.81,"10th_percentile":64.04,"90th_percentile":560.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":32.93,"10th_percentile":24.22,"90th_percentile":42.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":37.42,"10th_percentile":37.42,"90th_percentile":55.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":117.09,"10th_percentile":117.09,"90th_percentile":117.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"16","median_amount":34.98,"10th_percentile":26.52,"90th_percentile":200.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":134.71,"10th_percentile":134.71,"90th_percentile":160.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":115.95,"10th_percentile":114.84,"90th_percentile":118.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.83,"10th_percentile":121.83,"90th_percentile":121.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":2099.69,"10th_percentile":2099.69,"90th_percentile":2099.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":803.95,"10th_percentile":317.19,"90th_percentile":1761.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"108","median_amount":1284.12,"10th_percentile":214.02,"90th_percentile":2140.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":672.84,"10th_percentile":224.28,"90th_percentile":1126.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"30","median_amount":593.37,"10th_percentile":214.02,"90th_percentile":1498.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":352.48,"10th_percentile":88.12,"90th_percentile":704.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":2161.12,"10th_percentile":2161.12,"90th_percentile":2161.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":1409.7,"10th_percentile":1174.75,"90th_percentile":2584.45},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"17","median_amount":1346.75,"10th_percentile":224.46,"90th_percentile":2088.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"123","median_amount":679.56,"10th_percentile":226.52,"90th_percentile":1245.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":714.06,"10th_percentile":238.02,"90th_percentile":952.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":2184.18,"10th_percentile":2184.18,"90th_percentile":2184.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"16","median_amount":1387.79,"10th_percentile":977.36,"90th_percentile":2273.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":590.31,"10th_percentile":583.01,"90th_percentile":1073.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1643.51,"10th_percentile":1490.42,"90th_percentile":3190.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":2275.41,"10th_percentile":2275.41,"90th_percentile":2275.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":2955.0,"10th_percentile":2955.0,"90th_percentile":2955.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":3137.0,"10th_percentile":3137.0,"90th_percentile":3137.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":595.34,"10th_percentile":588.64,"90th_percentile":1086.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":618.49,"10th_percentile":618.49,"90th_percentile":618.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":1483.46,"10th_percentile":291.78,"90th_percentile":1483.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":423.96,"10th_percentile":423.96,"90th_percentile":423.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":1574.99,"10th_percentile":1574.99,"90th_percentile":1574.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":174.72,"10th_percentile":174.72,"90th_percentile":174.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":1503.09,"10th_percentile":1503.09,"90th_percentile":1503.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":175.09,"10th_percentile":175.09,"90th_percentile":175.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":17.25,"10th_percentile":17.25,"90th_percentile":54.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":19.24,"10th_percentile":19.24,"90th_percentile":19.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":178.48,"10th_percentile":56.36,"90th_percentile":444.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"98","median_amount":177.03,"10th_percentile":40.78,"90th_percentile":704.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"25","median_amount":21.37,"10th_percentile":11.48,"90th_percentile":50.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1109","median_amount":100.72,"10th_percentile":32.86,"90th_percentile":444.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"338","median_amount":28.19,"10th_percentile":16.88,"90th_percentile":85.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"23","median_amount":44.26,"10th_percentile":27.31,"90th_percentile":229.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"258","median_amount":178.84,"10th_percentile":42.9,"90th_percentile":581.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"31","median_amount":28.21,"10th_percentile":7.17,"90th_percentile":177.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":27.73,"10th_percentile":27.67,"90th_percentile":128.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"142","median_amount":35.84,"10th_percentile":15.67,"90th_percentile":101.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"16","median_amount":37.12,"10th_percentile":9.06,"90th_percentile":84.69},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"25","median_amount":28.34,"10th_percentile":17.9,"90th_percentile":197.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"129","median_amount":25.07,"10th_percentile":16.39,"90th_percentile":194.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"25","median_amount":27.16,"10th_percentile":16.39,"90th_percentile":247.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1549","median_amount":34.69,"10th_percentile":17.37,"90th_percentile":135.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"219","median_amount":28.58,"10th_percentile":15.61,"90th_percentile":122.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"114","median_amount":365.22,"10th_percentile":134.9,"90th_percentile":960.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"15","median_amount":132.5,"10th_percentile":82.59,"90th_percentile":595.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1022","median_amount":306.92,"10th_percentile":148.24,"90th_percentile":1037.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"191","median_amount":161.33,"10th_percentile":54.63,"90th_percentile":503.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"12","median_amount":259.16,"10th_percentile":149.07,"90th_percentile":402.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"409","median_amount":419.46,"10th_percentile":148.24,"90th_percentile":1320.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":395.72,"10th_percentile":183.67,"90th_percentile":764.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":227.83,"10th_percentile":70.97,"90th_percentile":676.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"83","median_amount":377.22,"10th_percentile":146.98,"90th_percentile":1183.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"18","median_amount":730.87,"10th_percentile":154.0,"90th_percentile":1559.23},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"31","median_amount":138.83,"10th_percentile":67.96,"90th_percentile":457.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"213","median_amount":428.45,"10th_percentile":147.33,"90th_percentile":1517.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"21","median_amount":739.62,"10th_percentile":281.35,"90th_percentile":1865.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"505","median_amount":178.47,"10th_percentile":55.39,"90th_percentile":515.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"134","median_amount":412.0,"10th_percentile":99.7,"90th_percentile":434.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":82.8,"10th_percentile":81.74,"90th_percentile":114.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1386","median_amount":351.26,"10th_percentile":351.26,"90th_percentile":379.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"220","median_amount":97.76,"10th_percentile":97.76,"90th_percentile":99.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"1 through 10","median_amount":281.0,"10th_percentile":281.0,"90th_percentile":281.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"413","median_amount":351.26,"10th_percentile":109.26,"90th_percentile":379.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":81.24,"10th_percentile":80.19,"90th_percentile":81.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":100.7,"10th_percentile":100.7,"90th_percentile":100.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"103","median_amount":460.0,"10th_percentile":436.0,"90th_percentile":460.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"31","median_amount":460.0,"10th_percentile":436.0,"90th_percentile":460.0},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"44","median_amount":99.7,"10th_percentile":97.76,"90th_percentile":102.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"205","median_amount":313.08,"10th_percentile":98.75,"90th_percentile":313.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"12","median_amount":313.08,"10th_percentile":313.08,"90th_percentile":313.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"627","median_amount":98.75,"10th_percentile":98.75,"90th_percentile":98.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"87","median_amount":103.74,"10th_percentile":103.74,"90th_percentile":103.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":197.5,"10th_percentile":132.52,"90th_percentile":1009.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":148.24,"10th_percentile":148.24,"90th_percentile":148.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":245.07,"10th_percentile":207.64,"90th_percentile":630.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":148.24,"10th_percentile":148.24,"90th_percentile":148.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":293.12,"10th_percentile":223.73,"90th_percentile":555.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":134.22,"10th_percentile":134.22,"90th_percentile":202.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"42","median_amount":402.03,"10th_percentile":148.24,"90th_percentile":889.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":195.63,"10th_percentile":114.31,"90th_percentile":672.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":499.4,"10th_percentile":252.0,"90th_percentile":1153.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":218.23,"10th_percentile":218.23,"90th_percentile":218.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":458.96,"10th_percentile":458.96,"90th_percentile":458.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"1 through 10","median_amount":1220.02,"10th_percentile":1220.02,"90th_percentile":1220.02},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":536.1,"10th_percentile":536.1,"90th_percentile":971.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":403.81,"10th_percentile":403.81,"90th_percentile":682.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":201.71,"10th_percentile":141.53,"90th_percentile":572.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"1 through 10","median_amount":57.91,"10th_percentile":57.91,"90th_percentile":57.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3476] [Observation (%BC): 57 Maximum Reimbursement 2395] [ED Level 1--99281 ($): 781] [ED Level 2--99282 ($): 781] [ED Level 3--99283 ($): 781] [ED Level 4--99284 ($): 781] [ED Level 5--99285 ($): 781] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 2000 (%BC): 55] [All Other OP (%BC): 57]","count":"1 through 10","median_amount":1406.29,"10th_percentile":824.0,"90th_percentile":2188.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Observation ($): 250] [ED Level 1--99281 ($): 50] [ED Level 2--99282 ($): 150] [ED Level 3--99283 ($): 250] [ED Level 4--99284 ($): 375] [ED Level 5--99285 ($): 375] [Critical Care ($): 500]","count":"1 through 10","median_amount":93.65,"10th_percentile":93.65,"90th_percentile":93.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1554] [ED Level 2--99282 ($): 1554] [ED Level 3--99283 ($): 1554] [ED Level 4--99284 ($): 1554] [ED Level 5--99285 ($): 1554] [CT Scan OP ($): 463.93] [MRI OP ($): 695.90] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 155.65] [Physical Therapy ($): 155.65] [Speech Therapy ($): 155.65] [OP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76]","count":"32","median_amount":1154.24,"10th_percentile":939.92,"90th_percentile":2463.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [ED Level 1--99281 ($): 1243] [ED Level 2--99282 ($): 1243] [ED Level 3--99283 ($): 1243] [ED Level 4--99284 ($): 1243] [ED Level 5--99285 ($): 1243] [CT Scan OP ($): 371.14] [MRI OP ($): 556.72] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 124.52] [Physical Therapy ($): 124.52] [Speech Therapy ($): 124.52] [OP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [Other Outpatient Implant ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 37.89] [Observation (%BC): 37.89] [Emergency Department (%BC): 37.89] [CT Scan OP ($): 441.84] [MRI OP ($): 662.76] [Occupational Therapy (%BC): 37.89] [Physical Therapy (%BC): 37.89] [Respiratory Services/Therapy  (%BC): 37.89] [Speech Therapy (%BC): 37.89] [Other Outpatient Implant (%BC): 37.89] [All Other OP (%BC): 37.89]","count":"1 through 10","median_amount":1974.54,"10th_percentile":1022.44,"90th_percentile":1974.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [ED Level 1--99281 ($): 261] [ED Level 2--99282 ($): 261] [ED Level 3--99283 ($): 261] [ED Level 4--99284 ($): 261] [ED Level 5--99285 ($): 261]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: PT/OT/ST - 225% of Fee Schedule] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation ($): 7942] [Emergency Department ($): 1818] [CT Scan OP ($): 579] [MRI OP ($): 869] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health ($): FEE SCHEDULE] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant (%BC): 76] [All Other OP (%BC): 51.75]","count":"1 through 10","median_amount":869.0,"10th_percentile":824.0,"90th_percentile":869.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [Observation (%BC): 59 Maximum Reimbursement 2737] [ED Level 1--99281 ($): 754] [ED Level 2--99282 ($): 754] [ED Level 3--99283 ($): 754] [ED Level 4--99284 ($): 754] [ED Level 5--99285 ($): 754] [Laboratory Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 7898] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 7170]","count":"1 through 10","median_amount":720.6,"10th_percentile":720.6,"90th_percentile":720.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Case Rates for SRS, EP Ablation, Hip, Knee, PTCA, Lithotripsy, Cardiac Cath] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 51.46] [Observation ($): 6713] [Emergency Department (%BC): 49.96] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 49.44] [Physical Therapy (%BC): 49.44] [Speech Therapy (%BC): 49.44] [OP High Cost Drugs (%BC): 76] [Other Outpatient Implant ($): 0 Charge Threshold 400 (%BC): 76] [All Other OP (%BC): 49.44 Maximum Reimbursement 6095]","count":"1 through 10","median_amount":715.48,"10th_percentile":715.48,"90th_percentile":715.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11789.94,"10th_percentile":11789.94,"90th_percentile":11789.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7214.68,"10th_percentile":7214.68,"90th_percentile":7214.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1980.0,"10th_percentile":1980.0,"90th_percentile":1980.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131250 | Total % of Charge: 55] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 7580 Days: 4 Additional Days: 1854] [Normal vag. Del. 3 day stay-Case Rate: 5119 Days: 3 Additional Days: 1854] [Normal Newborn-Per Diem: 674] [Lower Level Neonate-Per Diem: 1685] [Higher Level Neonate-Per Diem: 1685] [Severe Level Neonate-per diem: 2135] [Alcohol/ Chemical Dependency-Per Diem: 936] [Psych-Per Diem: 936] [Rehab-Per Diem: 1011] [IP High Cost Drugs ($): 0 Charge Threshold 2000 (%BC): 55] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 2000 (%BC): 55]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers] [Alcohol/ Chemical Dependency-Per Diem: 600] [Psych-Per Diem: 600]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 210600 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17166.88 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 11548.63 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1703] [Psych-Per Diem: 1703] [Rehab-Per Diem: 2486] [IP High Cost Drugs ($): 0 Charge Threshold 1000 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76]","count":"1 through 10","median_amount":14659.68,"10th_percentile":11561.05,"90th_percentile":16041.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Pathway Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 168480 | Total % of Charge: 40] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 13733.50 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9238.90 Days: 2] [Alcohol/ Chemical Dependency-Per Diem: 1362] [Psych-Per Diem: 1362] [Rehab-Per Diem: 1989] [IP High Cost Drugs ($): 0 Charge Threshold 800 (%BC): 70] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 320 (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":58.77,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HealthSpring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 82500 | Total % of Charge: 65] [Inpatient Services: Stoploss excludes Ortho and Cardiac case rates] [MSDRG Base Rate: FEE SCHEDULE] [ICU-Per Diem: 3076] [C-Section-Case Rate: 16260] [Normal Vaginal Delivery-Case Rate: 10981] [Rehab-Per Diem: 2870] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":40.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 102644 | Total % of Charge: 50] [Medical-Per Diem: 2737] [Surgical-Per Diem: 2737] [ICU-Per Diem: 3422] [CCU-Per Diem: 3422] [Psych-Per Diem: 1025]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2855] [SNF-Per Diem: 1343] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 30886 Days: 8 Additional Days: 2619] [PTCA-Case Rate: 12126 Days: 4 Additional Days: 2619]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Charter/Core/Nexus Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 119608 | Total % of Charge: 56.65] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2427] [SNF-Per Diem: 1142] [IP High Cost Drugs (%BC): 76] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 400 (%BC): 76] [Cardiac Surgery-Case Rate: 26253 Days: 8 Additional Days: 2226] [PTCA-Case Rate: 10307 Days: 4 Additional Days: 2226]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12128.2,"10th_percentile":7766.59,"90th_percentile":91249.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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